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PcRMIT APPLICATIVN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />�'� ��2 N�I VE A 1� 2 �utucr7 <br />LEGAI LOTNO. BLOCK <br />DESC. �. � 0 Z N I� <br />Lvis �cizn.:� <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />_Sr7 Ji1 �a 6 [ <br />WORK DESCRIPTION <br />PARCEL TAX I.D. # <br />oioy/JDo/ 002 Oo <br />TR>CT <br />N <br />22� �Dizu Avt A l02 Ev��zc�- "�3z��' <br />I CONTACT FOR PERMIT pHONE <br />ADDRESS <br />HEATSOURCE <br />_ Electric _ Gas _ Olhcr <br />l��d�n�sto�age room '��side �x�S�v� 9a�age. <br />/c�'—�I'' � /2'-/ �� <br />MBING <br />NO. I 1YPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/elcJ <br />Backflow prevenler <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. <br />CITYlZIP PHONE <br /># <br />�l,ts y�3�i <br />CCNTRACT PRICE OF WORK <br />//7 )dyY <br />� v /l <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas firepiace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhausl (an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correcL All provisions of laws and <br />ordinaces goveming Ihis type of �vork will be complied �vith �vhelher specified herein or not. The granling of a permil does nol presume <br />lo give aulhority lo violate or cancel lhe provision of any other state or local law regulating consWclion or the pertormance of <br />conslruclion. Thal I am aulhorized by the owner of this property lo perform lhe work for which app!ication is made and I compiy wilh the <br />Stale Conl. ctors 1a��18.27 RCW and 296.200 WAC. <br />✓ UCl-� � Cf2(LJ �� - ��- � b � <br />Signalurc of OwnedContractor/Authorized Agenl Dale � <br />%v <br />