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� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREFT, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />C�yot �.�rn���.d �Lt_ <br />LEGAL LOT NO. BLOCK <br />DESC. � 1� Q�S v is <br />{-IFalic:t� I3('�S, Hc�Pi1G5 <br />TENANTNAME <br />PARCEL TAX I.D. # <br />Oa.� HH'7�rS�rNo,3 <br />TRACT <br />P7�'t I-F�tfZST <br />��1 �, �. � "� � /kV c � N � <br />� CONTACT FOR PERMIT <br />��uc,1 1-I t��1� C�: <br />;V�RC-T i �-i4j2U$�� <br />PHONE <br />�LS-Z�`ID-Z.�12`1 <br />CONTRACTOR ADORESS CITY/ZIP PHONE <br />i��►�ck ¢2L��, 1�,^r,gs 39z2 ���+-" A��.Ne �iZS-39'7-7�Eo <br />CONTR. LICENSE # <br />HF'�i�C1<$T_O1 �',�, DZ Fr��R� T ; ���ZOS <br />USE OF BUILDING HEAT SOURCE I CCIJTRACT PRICE OF WURK <br />j����L�y. _ 2.1� ' <br />_ Electric � Gas Olher "1 � � <br />WORK DESCRIPTION • <br />N Ew ��a�-�x �c�'''�- �-� <br />TYPE OF FIXTUR[ OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washor <br />Waler healer <br />Sink (service/badmap/etc.) <br />Backilow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTUFE OR ITEM <br />A/C — air handlina units <br />Forced air syslems <br />Gas piping <br />Waler healer <br />Gas flreplace <br />Gas range <br />qothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refri�eration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby ceriti(y that I have read and examined lhis appli;:ation and know the same to be true and wrrect. All provisions of laws and <br />ordinaces c�oveming this type of work will be complied wilh whether specified herein or noL The granling of a permit does not presume <br />to give authority to violate or cancel Ihe provision oF any olher state or local law regulating construction or the perTormancs of <br />construction.'�hat I am authorized by the v+n r cf lhis properly lo perform the work for which applicalion is made and 1 comply slth tho <br />State o cter � 18.27 R W and 2. 0 C. f� I Z�IOr <br />� b <br />Signa ure of onlracror _�ed Ag nt Date � �� <br />2 <br />