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P�RMIT APPLICATI(���1 <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 />LEGAL LOTNO. dWGK <br />DESC. �� ��j 1 <br />OWNER <br />.� <br />c[>���1 /,C>l'�U��'Y) <br />TENANTNAME � <br />�, �� ,, <br />C.ONTR. LICENSE <br />USE OF <br />l � � <br />�� <br />�PARCEL TAX L0. # <br />��y�� r���vzyo <br />TRACT <br /># <br />; �i i-,, <br />/�9/� J��'I> i)/Z �tll�J " 11�1'IuJCGi� <br />f�0 ACT POR PEBMIT � � f PHC!!E <br />�7l �-� � - 3`,�- �> � � � � <br />��i �>'�5 - .�f6- �.��� ��—��i l�� � ., <br />ADDRESS CIN/ZI; � PIIONE <br />V1iu�'-� (�1p,�vtk�,�k. <br />/�%� i 4; z�1 I <br />�/� �� `I i� � I �.�1� L��-, �=Y 1��- J�/% <br />HEAT SOURCE CONTRAC7 PRICE C-'^'ORK <br />Eleclric � Gas _ Other <br />WORKDESCRIPTION �fG�ru �� ��ua�L(.1PJ] _ vu:.rsc— � <br />��f—�— �:��-�- `S � s ` <br />� � �-� e�e�r <br />NO. I NPE OF FIXTURE OR ITEM <br />Toilet <br />Balhlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dislnvasher <br />Clolhes washer <br />Laundry tray <br />Sink (servicelbar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher_ _ <br />Np, I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air syslems <br />Gas piping <br />Water healer <br />Gas firep�ace <br />=Gas range '�� I ry <br />Clothesdryer �� <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Re(rigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� I hereby ceritify that I have read and examined this appiication and know lhe same to be true and correct. All provisions of laws and <br />ordinaces 9oveming this rype of work wiil be complied with whelher specified herein or noL The granting o( a permil does not presume <br />lo give authonty io violate or cancel lhe provision o( any olher slale or local law regulaling construction or the performance of <br />I construclion. Thal I�m authorized�by lhe owner of this property to peAorm the � rk for which application is made and I comply �vith the <br />State Contraclors Law 18.27 RCW and 296.200 WAC. / <br />�� , c �r, c.—c��-<=✓sc�— �J� C f D J <br />SignaWre of OwnedContraclor/Authonzed Agent Date � h <br />if <br />