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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FiiOM 8 Ab1 TO 4 PM <br />SITE ADDRESS <br />�/�.S N�'T ,avt- <br />LEGA LOT NO. BLOCY. <br />�ARCEL TAX I.D. p <br />aos���a/ ov�vv <br />TRACT OR SUBOIVISION p <br />3 --S -� 7 <br />��/ <br />43"�,uU?r r�o<<,.� a�_�,u..c v�.�sN�-,„.� :Su,�A Ev�->cerr,9�o3 339-�3�E <br />TENANT NAME CONTACT FOR PERMIT PH�1NE <br />E-MAIL <br />AD <br />NfIIG��PAtC. NEe-n� T�-+� ��'lao�l aaU..1�fEK Gv�niE �,.ijGrs 9�I.i5� <br />CONTR. LICENSE p <br />�,o�vasv�`F �aov�3�s lyi� <br />USE OF BUILDING <br />G�G(MC, UM-�Gts <br />WORK DESCRIPTION <br />HEATSUURCE <br />_ Electric _ Gas _ Othcr <br />�NSTwi"- �SN�.IPuSr iia.� .t.. Dw�wuwL' <br />IN.�1��i MPIL6�Ni� A�1 N�K' '�: �lA�`�� <br />NO. I TYPE OF FIXT'URE OF ITEM <br />Toilet <br />E3athlub <br />Lavatory jwash basin) <br />Showcr <br />Kitchen ,ink & di;posal <br />Dishwasher <br />Clothes washer <br />Watcr healer <br />Sink (service/bar/mop/ctc.) <br />Backllow preventer <br />Urinal <br />Drinkin� fountain <br />Floor drain <br />Grease Irap <br />Roof drains <br />Olher <br />CONTRACT PRICE OF WORK <br />� � uu,� <br />NO. I TYPE OF FIXTURE OR ITEM <br />,_J_ /VC—airhandlingunits <br />_ Forced air systems <br />_ Gas piping <br />Water healer <br />Gas lireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />_j_ ExhausUan <br />Hcat pump <br />Unit heaicr <br />8oiler <br />_ Retrigera�ion <br />Woodslovc <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3f 05 <br />I hereby ceritily Ihat I have read and examined thi; application and know �he same to be lrue and correct. All provisions of laws and <br />ordinaces goveming Ihis type ol vrork will be complied with whether specitied herein or noL The granting ol a permit does not presume <br />lo give authoriry m vielale or cancel ihe provision ol anp other stale or local law regula�ing consWction or the per(ormance o� <br />tmction. That I arn �u!horized by ihe owner ot ihis p�operty to pedorm the work lor which application is made and I comply with the <br />Statc cnlractors Law 1827 RCW and 296200 WAC. <br />, �� YmA�H �� <br />J�s�N r1,�2T�,� <br />