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P�tRMIT APPLIC�TI�"Uld <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 ARE ACCEPTED S=ROM 8 AM TO 4 PM <br />SITE ADDRESS <br />a� SC. E��.ce� (�'1<t11 wa 5�.,,1�. <br />LEGA LOT N0``.- LOCK <br />� DESG S�l.l�. q�s.�C�VL� <br />I OWNER <br />� ��b�� � �n P�o(�,c'��-�� <br />� TENANTNAME <br />, Q �Srab�1+��������. <br />�"","„�„'" Ke.�rts�-, <br />i CONTR.UCENSE#Re�����-�c,���� <br />USE OF BUILDING <br />�C1C � ���5 �,�-ca � <br />PARCEL }�AX I.D. # <br />�1Sc �n'��4bC�0 <br />TRACT OR SUBDIVISION # <br />�S�GE�z�cNf <br />CONTACT FOR PERMIT <br />��ao� �.� <br />�� <br />q �a5-o% � <br />PERMIT # <br />n.�l � r� <br />S �t,�e. �� Eve�eN,1,.1� <br />AHONE ' LI�jU- i <br />�'J„i.Nr��Yj �Z-�0'Q�urU��'L�J-�PaIX <br />�'1Df Ca��1,W� q�oy5 <br />HEAT SOURCE CONTflACT PRICE OF WORK <br />'/ �proX�mGc�-�'�I <br />Eleclric r Gas _ Other �� r��� � <br />WORK DESCRIPTION I(\ j�-C�11�� j� (�� �Q\nJ ( <br />�1 C1CU�- <br />NG <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kilclien sink 8 disposal <br />Dishwasher <br />Clothes washer <br />___ Walerheater <br />___ Sink (serviceibar/mop/eta) <br />_ Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />� '-1 � � �C�S' C.��,� i i C' <br />I I <br />N0. I TYPE OF FIXTURE OR ITEM <br />_� A/C - air I�andling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas (ireplace <br />Gasrange <br />Clothes dryer <br />Rangehood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF E'JERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceri6fy that I have read and examined this application and know the same �o be true and correcL All provisions ot laws and <br />ordinaces goveming this type of work will be compfed with whether specified herein or noL The granting of a permit does not presume <br />to give aulhority to violate or cancel ihe provision ol any other state or local law regulating construction ur the performance of <br />constructio t I am authorized by the owner of this property lo pedorm the work for which application is made and I comply with the <br />S te Contr tor aw 18.27 RCW and 296.200 NIAC. <br />��1��r�ti �a� n�� s� `�� dsl n� <br />