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PERMIT APPLICATIdN <br />CITY OF EVER�TT P�RMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9820 i <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPt_ICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�I SITE ADDRESS PARCEL TAX I.D. # l �y 3 fr�S <br />�i ZI21 -�� f�� 4vrxti-�- k�Lo I 00 4�f 1 y 3y o I o oU <br />L[GAL L TNU. BLOCK TRACT <br />I �Es� ��: n k3H o-oa �1o�c.00 3�0�- �k <br />V�.usk� 2i21 <br />W i�r <br />r <br />PERMIT # <br />�(,r�' C� �- � S t� <br />`(z.s- 776- I166 <br />+�'�--�__ <br />TENANT N}SME `� �I CONTACT FOR PERMIT PHONE <br />� CG_�.�(,� �Dou.+u.�j- 425-Lks-o��fl <br />CONTfiACTOR Le�� n ((n� Tk` ADORESS � CITY/ZIP PHONE <br />YAtlf' -� ���.� �,r5 /� vl � �Q,�,oud W�4 �i�o5z, <br />CONTR LICENSE# <br />USE Of BUILDING �/ / <br />,l� 0.�(� �i�w � - F�Sic�t<cLCJ <br />WORKGESCRIPTION �_ f�a <br />PLUMBING <br />NO. I TYPE C�F FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwas:ier <br />Clothes washer <br />Launtlry tray <br />Sink (service/bar/mop/elc.} <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drein <br />Grease trap <br />Roof drains <br />Other <br />HFATSOURCE <br />� Eiectric _ Gas _ Other <br />NO. <br />�1L5•zd�5 v69► <br />CONT�2ACT PRICE OF WORK <br />/U� z3a' <br />MECHANICAL <br />TYFC OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas firepiace <br />Gasrange <br />Clothe; dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Und healer <br />Boiler <br />Refrigeration <br />WooCstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TA% CO�E IS 3705 <br />I hereby ceritify that I have read and examined this apphcation and know the same to be true and wrrecl. � II provisions of laws antl <br />ordineces goveming Ih,is ry��� of work will be complied with whether specifed herem or not. The granting of a permit doas not presume <br />to give authority to vio:a;e or cancel the provision of any ether state or local law regulating construction or the performance of <br />conslruclion. That I am authorized by the owner of this property to pertorm the work (or which application is made and I comply with the <br />State Contractors law 1827 RCW and 296200 WAC. <br />�%c1✓�^�"�^+�I Z- /-U�'' <br />