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SITE ADDRESS <br />�I o �o SE E� <br />LEGA LOTNO. <br />DESC. <br />TENANTNAME <br />��e�c5-� Co <br />� <br />� <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?M <br />BLOCK <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />ICONTACTFORPERMIT PHONE <br />Ter�my M��I�i e.Ma�, <br />�� -��-�v <br />ra <br />i2-7 <br />A2�-/213 <br />,nuC�<'�Fm-hvc.c�, <br />wn�n�.�.wrt quuKta3 � CITYIZIP PHONE <br />CFM Na��n�anclC'�clin�g,Tnc- �o. (�x 3zo5 I�;�Wur1 480�3 y?5-82�-/Z�j_3 <br />CONTR. LICENSE # „ _ <br />USE OF BUILDING <br />�l�oo � <br />HEAT SOURCE I, CONTRAC? ?RICE OF WORK <br />�/ I df' � <br />/� Electric Gas Other y� , 3Ga <br />WORKDESCRIPTION �n5''"GII � n�i.0 V.�✓ �CX Ci�� ���'(.(;p/k �e�'�(�,yj Q� GI!'`�� <br />fe�oC��iio� � c� 6.C��+;nJ vqv bcxz� `� <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash 6asin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes w2sher <br />Waler heater <br />Sink (service/bar/mop/etc.) <br />BackOow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air hantlling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heatpump <br />Unit hea:er <br />Boiler <br />Refrigeration <br />Woodstoy� <br />Other yfl✓ �X <br />nuc wor f �✓�'Sion S <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 1105 <br />I hereby certify that I have read and examined this application and know the same to be true and corcect. All provis�ons of laws and <br />ordinances governing this type of work will be complied with whether specified herein or noL The granting of a pertnil does not presume <br />to give authority to violate or cancel the provision of any other state or lowl law regulating construction or the perfortnance of <br />construction. That I am aulhorized by the owner of this property to perform the work for which application is made anA I compiy with the <br />State �ortQactors Law 18.27RGW �nd 296.200 WAC. <br />� /2-1,�-i p <br />