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SITE ADDRESS <br />LOT NO. <br />TENANTNAME <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # P�� <br />ll s�6z� 2'3O5'3'�S�I <br />BLOCK� TRACT <br />AUDRESS CIN21P PHONE <br />S�-' SC: ��ar:.iN' �'v1�.11�n1;a- E�,�,,rt11 `1'�2�'! <br />�z� — <br />I CONTACT FOR PERMIT ' PHONE <br /># <br />�3 ' <br />�� <br />. <br />1'1<'l%C,� GJ•�1 i�iP:'�� I�UA;fIC� Lo%�• �IZ�•3a3-�/173 <br />CONTRACTOR r�,��>ll I� �V' i'�� �D�� CITY/LP PHONE �;,� �, J 3�iy- <br />` �Ror ++4rb�.�� F(Gr.e saea�s iviv kSl�+ao 9 s xzs- � v u v <br />coritR. uc�se s <br />USE OF BUILDING <br />� i ��" �'1 <br />HEATSOURCE <br />_Eledric _Gas_Other <br />WORKDESCRIPTION FCz.w�,��h✓��� L)c�`,�fi�v�c� <�'���u..c:(i . �� <br />J <br />{��l.iW��t�c�'Fu:l L'�^(��,ev��� \L'��r �;C���. <br />NO. � TYPE OF FIXTURE OR ITEM <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbar/mopletc.) <br />Badcflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof dreins <br />Other <br />CONTRACT PRICE OF WORK <br />� 7 a � <br />�oC.. iV�.t+G-��t�.S <br />NO. I 7YPE OF FIXTURE OR ITEM <br />AfC - air handiing units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireptace <br />Gasrange <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigr.ralion <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9106 <br />I hereby ceritify that I have read and examined lhis applicatlon and know lhe same to be We and correcL All provisions oi laws and <br />ordinaces goveming this type oi work will be complied wilh whether spedfied herein or not The granting of a pertnit does not presume <br />to give authorily to violale or cancel lhe provision of eny other state or local lew rcgulaGng conslruclion or ihe perfortnence oi <br />consWction. Thal I am aulhorized by lhe owner of this property to periorm the vrork for which appllcation is made and I comply with the <br />State C�ntsactors Law 1827 RCW and �.20_. 0 WAC. � <br />�� % � - - �-" <br />Signature o OwnerlConVactorlAuthonzed Agent Date �/1 <br />1 h/ <br />\.!Y <br />