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rERMIT APPLICATiJN <br />�ITY OF EVERETT PERMIT SERVICES <br />320� 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 ADDRESS <br />LOT NO. ' <br />� <br />TENANTNAME <br />\ CC,(� `�Q-C� <br />CONTR. <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. <br />PARCEL TAX I.D. # <br />'�ILFE�Ia�l.;c� <br />TRACT <br />���( VG1�CL0.1t111 <br />CONTACT FOR PERMIT <br />'A-�� I �Sf�YI <br />C��A`DDRESS <br />��v_ <br />J-c� �:= OJcax <br />�1� I_l���YY\ O�if�(` L k F� <br />CITY2IP PHONE <br />�l�l.f'�z���� <br />�� <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Elec!ric _ Gas _ Other � I � ��_ <br />�l`��t�Ccr_�h�� �a -��v� , ���,n1c.�e�' �L�S��'� <br />19�Ili�il:71� <br />TYP'e OF FIXTURE OR ITEM <br />Toilet <br />6a1hWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry Iray <br />Sink (service/bar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grcasetrap <br />Roa( drains <br />Olher <br />NO. <br />MECHi,NICAL <br />1 YPE OF FIXTURE OR ITCM <br />A/C — air handling units <br />Forced air systems <br />Gas pipinc� <br />Water healer <br />Gas (ireplace <br />Gas range <br />Clolhes dryer <br />Ranc�e hood <br />Exhaustfan <br />Heat pump <br />Unit healer <br />B�iler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERE7T LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know lhe same lo be true and correcL All provisions of laws and <br />ordinaces governinc� this typo of work will be complied wilh whether specified herein or nol The granting of a permit does not presume <br />to give aulhorily to violate or cancel lhe provision of any other slale or local law regulating construclion or the pedormance of <br />cons4�uc'ion. Thal I a authorized by lhe owner o( Ihis property lo perTorm the work for which application is made and I wmply wilh lhe <br />Statd Cpnlractors Le�B� �7 RCW,and 29G.200 W/AC. � C� <br />� � � ;1,� � ,r����✓�! �/ � , / � I� L. � <br />Sionaturc of Owner ConhSctor/Authorized,dg nt Date /� <br />C� <br />