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SITE ADDR�SS ^ <br />Iwn2- yr ��1 <br />LEGAL LOT NO. <br />DcSC. <br />PERMI� APPLICATION <br />ClTY OF EVERF"TT P'ERMIT SERVICES <br />3200 CEDAR STREET, EVERETi, WA 98201 <br />425-?57-8810 - F/�X 425-257-8857 - www.everettwa.org <br />APPIICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ti�ry-r� ur�g <br />B! OCK <br />PARC� TAX I.D. # <br />� ���1c>; ��vd �/o/ ��c� <br />TRA4T OR SUBCIVISION # <br />�s�}ppqyt GaMPANL�-'S lA'�'%'�� MAX58�lT) NEWPol�r $EaGN, cq g2660 9�f9-45�- o�oo <br />x /�.z8 <br />TENANTNAME � CONTACTFORPERMIT PHONE �{�z�2�3�3� <br />q�PosrACE <br />7sD <br />CONTR. LICENSE # <br />USE OF BUILDING <br />MEW�1`�TIt�E <br />T�sse �mi.e� <br />HEATSOURCF <br />✓Electric Gas Oiher <br />CONTRACT PRIGE Uh WUMK <br />�/PZ, OOD <br />WORK DESCRIPTION � �,. ��y�� yToR�) UF R f�' bEHIS�v <br />�,oM�M�c.z�►c�i MF�%��1' �3�3, c4 '!-�'tAu <br />yv, .� xN <br />N0. I TYPE OF FIXTURE OR ITEM <br />/ Toilet <br />Bath�ub <br />! Lavatory (wzsh basin) <br />Shower <br />Kitchen sink & disposal <br />D�shwasher <br />Clothes washer <br />� Water heater <br />Sinl< (service/bar/mop.ie�c.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />� Floor drain <br />Grease irap <br />Rooi drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEld <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />W ater hea�er <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigera�ion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined ihis 2pplication and know the same to be lrue and r,orrecL All provisions ot laws and <br />ordinaces governing Ihis type of work will be complied with whelher specified herein or not. The granting ot a permit does not presume <br />to oive authoriry to violate or cancel �he provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property lo pertorm the work (or which application is made and I comply with the <br />State Contractor� RC and 296200 WAQ — <br />G/�/o� <br />Signature of OwnedCoNractor/Authorized Agent Da�e ./Z <br />