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PERMIT APPLICATIOIV <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 FROM 8 AM TO 4 PM 9` <br />`1�1 sG EUFa�� M�c. <br />LE6AL LOT NOL. BLOCK <br />DESC. O/�J S�'1 �t:T �� i• J <br />� a�� gu st ��s5 c <br />TENANTNAME <br />�j n.iB � �i� «-c-�-r�S <br />�CC /i'f2 COAIi��- <br />2 �o Pg <br />USE OF BUILDING <br />f� �l�c �— <br />PARCEL TAX I.D. # <br />' � OSl � !J C� 2 Oi <br />TRACT OR SUBDIVISION # <br />I�O (�&SiR. <br />LLC ,Sur� St��i <br />CONTACT FOR PERMIT <br />��� � <br />(812 <br />��G�Y <br />PERMIT # <br />�f0o jM 90°I-1-� <br />7 CITYIZIP PHONE �p <br />p�''c S�-A /4Hr �9 ��y- 5�s� <br />PHONE 'I�(��(F��a' L— �n> � <br />N��� c���K <br />N• -�'ro � <br />HEAT SOURCE <br />�Elec�ric _ Gas _ Olher <br />WORK DESCRIPTION <br />IVl ub i/=�/ � �TiJOGZK �� u-/ <br />1. �. P�= ���, � ss � c. ��,n-i <br />NO. I � TYPE OF FIXTUHE OR ITEM <br />Toilel \ <br />Bathlub <br />_ Lavalory (wash ba in) <br />Shower <br />Kitchen sink & disposal <br />_ Dishwasher <br />Clolhes washer <br />Water heater <br />_ Sink (service/barlmopletc.) ,. <br />Backtlow preventer <br />Urinal <br />Drinking Foun�ain . �' <br />Floor drain <br />Grease �rap' <br />Rao� �ns <br />= OI � — --- <br />� �Z.. c—x� s�r�N E, <br />E•MAIL <br />��80� 2oe-E�8z-�3`l3 <br />� CONTRACT PRICE OF WORK <br />I ��j—�UOO,UO <br />�-} �- ! (� � %Z N �cGJ <br />6ur��JrrJ(� ,��/zA,�r i'-� i3 uqpg -03-0 <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling uni�s <br />Forced air systems <br />Gas pipinc� <br />Waler heater <br />Gas lireplace <br />Gas range <br />Clothes dryer <br />Ranc�e hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Relrigeration <br />Woodslove <br />Other IJ�(Gi1���k-r �!(�f'��S r <br />--G-�� iE'C�1N(. SFA-CE. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify thal I have read and examined Ihis application and know Ihe same lo be irue and correct. All provisions of laws and <br />ordinaces c�oveming Ihis type ot work will be complied wilh whelher specified herein or n�l. The granling of a permit does not presume <br />lo give aulhori�y �o violale or cancel the provisinn of any olher state or Iocai Iaw regulaling consiruclion or the pertormance of <br />consiruclion. Thal I am aulhorized by ihe owner of Ihis property to perlorm Ihe work lor which application is made and I compty with Ihe <br />St e Contractors Law 18.27 RCW and 296.200 WAC. <br />��-�- G �--o � / 7�� `/� <br />