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SITE ADDRESS <br />-Tfl� (�o� <br />31 � 32 <br />'k�� U�ecc�5 <br />TENANTNAME <br />CONTRACTOR <br />PcRl4'lIT APPLICATICJN <br />CITY OF EVERETT PEt�I1�IfT SERVICES <br />3200 CEDAR STREET, 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 />TAX I.D. # <br />i I� Zc�1� 0��(S��S 13(�03 I o0 <br />3LOCK TRACT <br />i3� (�„��v��w nad�ti� ���� � <br />���a� �U'�� -711��1-�y-i-�tR. <br />CONTR. LICENSE # <br />�;�1 L4i �� <br />USE OF BUILDING <br />Sj-�` r�2t_SrO�-n!'7;�L <br />WORK DESCRIPTION <br />'' � j2r�+�� le f . <br />U a•;�=w�c�. r <br />%�c�!i (�u��wvt,i+� /LturuLi-Yi-I <br />1 i�ti�s lti w:�l�, c�.��Q c.�,l, <br />YUZ'rv� <br />Np, I TYPE OF FIXTURE OR ITEM <br />Toilel <br />BathWb <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />CONTACT FOR PER <br />J� ���1�/U�Lt�� <br />ADDRESS <br />IT # <br />i//'v% <br />zal 31.�-(;51-47� <br />1�' 3L{)-(n51-`i1��'-� <br />p,t - ��z5-�75 - SS�I(� <br />CITYIZIP <br />PHONE <br />PHONE <br />HEAT SOURCE CONTRACT PRICF OF WORK <br />_ Eleclric � Gas _ Other � ��'�Z l <br />�Lt6Vi. in�L W 11�c�Uru �,.�{y�,15A. � �t�2ri <br />N0. I TYPE UF fIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhausltan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby cerilify thal I haae read and examined this application and know Ihe same to be true and correct. All provisions of laws and <br />ordinar,es governing this rype of work will he complied with whelher specified herein or not. The granting of a permit does not presume <br />lo give authority to violate or cancel the provision of any olher state or local law regulating constn,clion or the performance of <br />construction. T�i-+a� aulhorized by the owner of lhis property lo perform the work tor which application is made and I comply with the <br />Slate Cbnlracl6rs Lawy8.27 RCW and 29G.200 WAC. <br />�/-2/-�b� <br />