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pE�2MIT APPLICATI4�� <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 />n U �{Ui-GzC <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE A�DRCSS <br />�y'� St: <br />LEGA LOT N0. <br />,c� �%iit J[9� <br />TENANTNAME <br />G�Fc �x� ;� <br />�-���i/!/FC( ����L <br />BLOCK TRACT - <br />CONTRACTOR KCU�i� SGrr /'Lu ��0�'�' <br />CONTR. LICENSE # ,('Ln(J��r���,7L G Z <br />USE OF BUILDING <br />G'!'�S / n( a <br />WORK DESCRIPTION <br />NO. � TYPE OF FIXTURE QR ITEM <br />iouet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service�bar/mop/etc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other �-t�l'�F.' `Lrr»s.Ft/� <br />PARCEL TAX I.D. # <br />Sf�'EUe�c,�''_�H�.a(( �--��F <br />ICONTACTFORPERMIT <br />%i'ri/ � .�.c� c <br />AO�RESS <br />29 37o-/�t�rlc <br />HEATSOURCE <br />_ Electric _ Gas _ Olher <br />CITY2IP <br />,�.L�Li.rS7�y7 <br /># <br />PHONE <br />�fz.� -'��-v-vf6 k <br />PHONE <br />�7�-"LZ3 <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />wc — air nanaiing 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 fan <br />Heat pump <br />Unit heater <br />Bailer <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby ceriti(y that I have read anQ 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 with whether specified herein or not. The granting of a permit does not presume <br />to give authority to vblate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction� That I am uthoriz d by the owner of this property to pe�orm the work for which application is made and I comply with ihe <br />State CoQtr�3ctor,w,i�aw�827J�W and 296.200 WAC. <br />