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P�RMIT APPLICATI(.,�� <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 AI:E ACCEPTED FROM 8 All4 TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />�G..-<--�, � . <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />TENANTNAME <br />PARCEL TAX I.D. # <br />BLOCK I ' TRACT <br />CONTACT FOR PERMIT <br />PERMIT # <br />PHONE <br />��v�m�.r�� _ � C'����e A�21 �2�y81�7��09 <br />�ONTRACTO ADDRESS CI /ZIP PHONE <br />t'Own ��r�, �Qrc�tc�-�Un �Fq32 �n/.ln;Ervr�,r+ f31v� y.2S•4gl•7(cf,9 <br />CONTR.LICENSE# �(�.��`�� W� q�''Z <br />(� f2fl�►�AttNf�44� � <br />USE OF BUILDING <br />�2�A.�� <br />WORK DESCRIPTION <br />f�dd q heads <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry t ay <br />Sink (service/6ar/mop/etc.) <br />BackFlow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />HEATSOURCE <br />_ Electric _ Gas <br />ONTRACT PRICE OF WORK <br />Other � 9(/D• "� <br />� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas f replace <br />Gas range <br />Cluthes dryer <br />Pange hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT. LOCAL SALES TAX CODE IS 9105 <br />I hereby ceritify that I havr read and examined this application and know the same l0 6e tn.e and correct. All provisions of laws and <br />ordinaces goveming this rype of work will be complied with whether specified herein or not. The granling of a permit does nct presume <br />to give authority to viol2te c- cancel lhe provision of any olher state or local law regulating construction or lhe performance of <br />construction. That I am aulhurized by the owner of lhis property to perform lhe work for which application is made ar.d I comply w�.h the <br />State Coiltrectors Law 18.27 RCW and 296200 WAC. <br />