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SITE ADDRESS <br />a.i s. �. ��� <br />OESC. <br />TENANT NAME <br />P�RMIT APPLICATI(�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA £8201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />mA �� <br />PARCEL TAX I.D. # <br />TRACT <br />CONTACT FOR PERMIT <br />L C�// - o�l� <br />P�MIT # <br />� .5 // - <br />PHONE <br />L✓\(�C\iSs `�RKhClS I 7l�Lh Uillhli Cl�� �{r0-ij�j0 '�i�sU <br />CONTRACTORCkS�(an� �<$�5�:, J.��� ADDRE55 CITY2IP PHONE JG� ����i� <br />Ys3 ��..fti�k7 Sd. 6c6i,hqh��,,98�a� <br />CONTR. LICENSE # C, � i < � � � <br />`�?Zm U <br />USE OF BUILD�NG <br />WORKDESCRIPTION �����,� <br />..�3.�Z J�/�.� C��Ahh<� <br />HEAT SOURCE <br />_ Electric _ Gas _ Other <br />Eki���aS Ya sy.f•i <br />,�'�oti s,sh • <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />BackOow prsventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />� <br />CONTRACT PRICE OF WORK <br />�yJ��<�o <br />�' J �s%aN <br />NC.✓ <br />TYPE OF FI%TURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust /an <br />Heat pump <br />Unil heater <br />8oiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TN( CODE IS 3105 <br />I hereby ceritify lhat I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied wilh whelher specified herein or not. The granting of a permit does not presume <br />to yive authority to violate or cancel the provision of any other state or tocai law regulaling construcdon or the performance of <br />construclion hat I�ar�authorized by the owner oi this property to perf�rm the work for which application is made and I comply with the <br />State.G actors La�v i�8.27 RCW and 296.200 WAC. <br />//� /L�OS <br />