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PERMIT APPLiCATiON <br />CITY OF EVEF•'ETT PERMlT SERVICES <br />3200 CEDAR S-i REET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org �Z .- O � — � % <br />�� APPLICATIONS ARE ACCEPTED FROM 8 AM 'f0 4 PM <br />SITE ADDRESS 3�p�. � ���> F.>RCEL TAX I.D. # <br />�L,�L��te+� �kJt. tv"c- `�7%3������I3fJvL�) <br />LLGAL LOT N0. rr� BLOCK LS'RACT JR SUBDIVISION # �- <br />DESC. ��� 4�,� ��� ` �(�'fi- C� f N�� 1� �� �% '� <br />'-tiV'v1A� tJ1�_ -;�,o« Z. <br />TENANTNAME <br />tiv.tic <br />CONTRACTOR 1 - �ti �,L,�L <br />CONTR.LICENSESR-�q`Cc-v �a7��-y1' <br />USE OF BUILDING <br />�.tit,��'�i i-A.�� ��i > �ti`','h_ <br />^h ` <br />;' J�t <br />CONTACT FOR PERMIT <br />K�ti �=�,���.� <br />�i�o�iCRt.�.iJ %'� <br />/�?��ti�r�L� �'�tz� <br />HEATSOURCE <br />Electric �Gas Other <br />7 <br />�/� <br />'ioq-(;u�i� <br />PHONE Z��,-�c;ury-Gc%=,? <br />E.MAIL C�iIM1Z�f�%;. <br />Q-�-'S-�i>' �S�Z <br />i10 c . <br />CONTRACT PRICE OF WORK <br />c,, , <br />�i �iL�l�i <br />WORKDESCRIPTION �tl�� C.x;Z/itm1= � Cu.nJ1c"rt �i'"Lv1L�ti�� ��u��7 Ck- Z�A�ivC <br />�IJCL-��i�ni.-. �' (o�ijll•v'> �}�:l"1�'�+ �hl..�R��li'UJKNPJ� �i��/17/�7'IOh� � {-'��in\.4(�� FC�'rl"'%-i u'�CLH^�'(.q-t. <br />T(.V,�N�71Mb� 1�L�1Z-\1/hL� \��nC�'1✓�, ,�SiP�w-c��r h•�SS�+, «,tiJs�'i�c' /;.L,.�i �1'L� �I IYL12 <br />l���i2 j�iC�VtiCi-S � �CJI'nil=1C, <br />PLUMBING MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />lZ. Toilet <br />c:; Bathlub <br />� L Lavatory (wash basin) <br />�. Shower <br />4- Kilchen sink & disposal <br />4 Dishwasher <br />i3. Clolhes washer <br />�Water heater <br />Sink (service/bar/mop/elc.) <br />� Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />�t <br />A/C - air handling units <br />Forced air syslems <br />Gas piping <br />W ater lieater <br />Gas fireplace <br />Gasrange <br />Clolhes dryer <br />Range hood <br />Exhaus ian <br />Heat pun:� <br />Unil heater <br />Boiler <br />Refrigerafion <br />Woodstove <br />Olher ct� � �v r <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerili(y that I have read and examined this application and know the same lo be lrue and correct. All provisions o( laws and <br />ordinaces governing lhis type of work will be complied with �vhelher s�eci(ied herein or not. The greniing ot a permit does not presume <br />lo give autho�iry to violate or ncel the provision of any olher state or iocal lativ regulaling consWr,tion or lhe performance u( <br />conslruct�n. Thal I am aut or�zed by the owner of this property lo pe�form the wo. k for which application is made and I comply with the <br />State C�xitractors Law.48 7 RCW and 29G.200 WAC. <br />a <br />��. <br />;� <br />v <br />