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PERfVIIT l�PPLICATION <br />CITY OF EVERETT PERMfT SER\/ICES <br />32J0 GEDAR STREET, EVERETT, WA 9820i <br />425-257-8810 - FAX 425-257-8857 - www.evere:twa.org I�/0-'D� <br />APPLICATIONS ARE ACCEP i cD FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # <br />�`105 LUrs1B��'2-� RiC. OOS�i4'7o�,s'vr�OH <br />LOT NO. I ELOCK TRACT <br />I`� ��5 � UIS �SNc"I+v'R-ST <br />I-{t�r�ck 3Rus, ��oa�nes <br />TENANTNAMG <br />CONTRACTOR <br />�-,��C�C Cj(LOS. �"1dlM� <br />CONTR. LICFNSE # <br />I-Fn�,c1� B'= O I c�, 7� Z <br />USE OF BUILDING <br />1���'�e� <br />WORK DESCRIPTION <br />aa a-�+�A��,.Nc I <br />CONTACT FOR PEi21dIT <br />S�e1 1•�aUC�< <br />ADDRESS <br />3�122 Fs7�`A�E �J C <br />C.vere�-1- ' <br />Ne �., p�rl� x <br />NO. I TYPE OF FI:CTURE OR ITEM <br />Toilel <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposai <br />Dishwasher <br />Cblhes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Back(low prevenler <br />Urinal <br />Drinking Fountain <br />Floor dr�in <br />Grease trap <br />Roo( drains <br />Other <br />HEAT Sl"rURCE <br />c,�:� O� I a t� � <br />PERMIT # <br />�O�o/O ' �5 � <br />uC-2C-'� � �I�Z.QS �25-39�-�36J <br />PHONE <br />�-125-���-242i <br />CITY2IP PHONE <br />�125 3��-'73(�0 <br />_ _ Electric � Gas _ Other <br />qS2os <br />CONTRACT PRICE OF WORK <br />2yo r <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />� Porced air syslems <br />�Gas pipin� <br />Waler heater <br />� Gas fireplace <br />_� Gas range <br />,� Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />i hereby cerili(y Ihat I have rc-ad and examined this applir.ation and know the same to be true and correct. All provisions of laws and <br />ordinaces governinc� this type o( work will be complied ivith whelher specified herein or noL The granting o( a permit does nol presume <br />to give authority to violate or cancel the provision of any olher slale or Iocal law regulating construclion or the per(ormance of <br />consiruction. That I am authorized by lhe own r o( this p.operty to perform the work for which application is made and I comply with the <br />Slale lractors� 1827 RCW� 29620 AC. / <br />r3\ `�/� <br />�� <br />? <br />