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PERMIT APP'LICATION <br />CITY OF EVERETT PERMIT SERVICE� <br />3200 CEDAR STREET, [VERETT. 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 />��7cG� E�/c.Le�rrl,ftL c•,, �, <br />LOT NO. <br />l.«�ti�v� :�.r✓�'s <br />PARCEL TAX I.D. # <br />BLOCK I TRACT OR SUBDIVISION # <br />i�L f.+aST SJUTiF- fEM�GC ..J✓ l'!-` /.SiX� <br />� -ao --o� <br />��J o�o� -��v� <br />5t�(i 03��'3c> <br />PERMIT # <br />d��os-oas <br />� sMcr uieL cl7N, rlla•-t- <br />TENANT NAME CONTACT FOR PERMIT PH N <br />,r:aMG .aJ �4Qr�'G <br />E-MAIL <br />CONTRACTOR A�DRESS CITY/ZIP PMONE <br />UZU:YIS#�[9��'L�' <br />USE OF BUILDING <br />/[ c.IT-+v �r�� ��rT <br />WORI( DESCRIPTION <br />�/�w �z�s�,tv�z.�T' <br />NO. I TYPE OF FIXTURE OR ITEM <br />� Toiiet <br />Ba�htub <br />� Lava�ory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />� Dishwasher <br />Clolhes washer <br />� water heatei <br />� Sink (service�badmop/e�c.) <br />Back(low preventer <br />�_ Urinal <br />Drinking Fountain <br />� Floordrain <br />Grease irap <br />� Roof drains <br />Olher <br />yZ i'� IP 1 I'a1�1 O�f.1-rtJJ <br />Fww <br />NEATSOURCE <br />Electric � Gas _ Other <br />CONTRACT PRICE OF WORK <br />} / yr r�, `�v`� <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC - air handling units <br />Forced air sys�ems <br />U'as piping <br />Water heater <br />Gas lireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other N4r%t1J�/u� <br />H,.trC u? Ja�s.0 �u�r' <br />CITY OF EVERETT LOCAL SALES TA% CODE IS J705 <br />I hereby ceriiify �hat I have read and examined lhis application and know ihe same to be true and correcl. All provisions of laws and <br />ordinaces governing ihis type of work will be complied with whelher specitied herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating constmction or ihe performance of <br />consiru�o �TI�� autho�by ihe o��er of lhi� roperty to pedorm the work for which application is made and I comply with ihe <br />S�ate Coniraclo 1827 and 296.2 ��AC. � r��� JQ���� �1 pJ�h>-/,y�N .( 5,.�. <br />� � <br />Da v ��L <br />/�tJSTi-� G�Jaj- �.F �fC e-i / T�'L ��� <br />� i � 9 . � 7 .<: iI n'i[_ .MA' , , , .r � _ <br />TG�)y:'�� �c(ei- 9�' v1�Y �v i3� $.ri' y.�0a <br />