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P�RMtT APPLIC�T!(�N <br />CITY OF EVERETT PERMIT 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 />SITE A�DRESS PARCEL TAX I.D. # <br />�/L /-lo�'T.' �� uvy��Sl�l;e3io� <br />LEGAL LOTNO. BLOCK TRACT <br />oesc. � i 5 3"Z I>� C�¢ar�ov�� ,Qo��z^- T� Cvanc=T <br />�% c�n� <br />TENANTNAME <br />CONTRACTOR <br />l.�o�o s <br />i rrc c�A-C'Ac-B� <br />CONTR.LICENSE# �'AC/F/G I�ISr�SN <br />USE OF BUILDING <br />� q r'/, l� � <br />7/ G� /-lz,yT /�, � F vc-,erT/ L✓A <br />I CONTACT FOR PERMIT <br />ADDRESS CITYIZIP <br />z7��, .C�-_ee2 ,4�e j-�tc� <br />� !�iZt I <br />IT # <br />r^"�` ;Le Gs� `i'v,- <br />�� j ?L'i� <br />PHONE <br />J.NRI� <br />y� i - �� �3,, <br />HEAT SOURCE � CONTRACT PRICE OF WORK <br />ti•�N� <br />_ Electric _ 3as _ Olher -'-y LY�C� - �• ✓ <br />WORK DESCRIPTION <br />�UA,�`>%2��<'i n�Gw �G`/ Sc2 1—� <br />NO. I TYPE OF FIY,TURE OR ITEM <br />Toilet <br />Balhlub <br />�.avatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Uishwasher <br />Cbthe.s washer <br />T Laundrytrey <br />Sirk (service/bar/mop/etc.) <br />Back(Iow prevenier <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />� <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Heal pump <br />Unit healer <br />Boiler <br />ReGigeration <br />Woodsiove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />i hereby ceritify lhal I have read and examined this applicalion and know the same lo be lrue and correcL All provisions of laws and <br />ordinaces goveming this type of work will be complied wilh whelher specified'nerein or noL The granting of a permit does not presume <br />lo give authority lo violale or cancel the provision of any other slate or local law regulating construclion or the performance of <br />consiruclion. That I am aulhorized by the owner of lhis property lo per(orm lhe work for which applicalion is made and I comply with the <br />State Contractors La�y 18.27 jtCW and 296.200 WAC. <br />// ���U S �--. <br />Date � <br />L <br />