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PERMIT APPLICATtOfd <br />CITY OF EVERETT PERM�T SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-0£S10 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FflOM 8 AM TO 4 PM // . aD-O�i <br />SI7E ADDRESS (.O�ri rv.i-lz- PARCEL TAX I.D. # PERMIT # <br />S��G 5-Z"d �2 9�2oi� Iz`60�U5o�`l01`ro� '�ll "�33 <br />LEGA LOT N� BLOCK TAACT OR SUBOIVISION # <br />�� a n <br />?ENANT NAME <br />�7� <br />•---..___ .... .._.. . .._..,.�2 S J <br />/ 5 90 l� S Z �d '� v.c_ �.�.,.,�.�-� �� Z o�. 3 3'� - 8 3i v <br />GVI'11HFl.IVH. <br />WQSJ1�n�� Lll��'' � Q <br />CONTR. UCENSE p�� 4��• ��9`S� �.� <br />USE OF BUILDING <br />CONTACT FOR PERMIT <br />� <br />/',;��(c,,�n r/i� <br />PHONE <br />E-MAI�OTW���l�I flCCIr.VW(U' <br />PHONE � <br />/�5J0 JZ��har� �1l'l,���j��� �fOJ- <br />��.�/Ce���� �� %�'�aS `77g-�SfSSf <br />HEAT SOURCE - CONTRACT PRICE OF WORK <br />_ Eleclric _ Gas _ O�hel _' , %�J � <br />WORK DES(:qIPTION �' // �% <br />1.���- t7t-"� L ' � .l.l,�-i_�-f'! C (, U ��i � ��Y-�2 <br />NO. I TYPE OF FlXNRE OR ITEM <br />Toilet <br />Bathtub <br />Lava�ory �wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwashcr <br />Clothes washer <br />� Waten c�atcr <br />Sink (serviceNadmop/elc.) <br />8ackllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Irap <br />Raof drains <br />Olher <br />NO. I TYP[ OF FlXTURE Ofl ITEM <br />NC �- air handling uNts <br />Forced air systems <br />Ges piping <br />water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Rangc hood <br />Exhaust fan <br />Heat pump <br />Unit hea�cr <br />Boiler <br />Reirigeration <br />Woodstove <br />CITY OF EVEBETT LOCAL SALES TA% COUE IS 3105 <br />I hereby ceritity Ihat I have read and exam{ned �his applicalion and kww Ihe same to be true and cormct All provisions of laws and <br />ordinaces 9ove: nin� this rype ol ttirork will be compiiad wilh whather specilied herein or noL The granting ol a permit does not presume <br />to give authoriry to violate or cancel Ihe provision ol any other state or loca� law regulaling constmction or the pedoanance of <br />consiruclion. Thai � am authorized by the owner o( ihis property to pedorm ihe work for which application is made and I romply with Ihe <br />State Conlractors Law 1827p RCW and 296.200 WAC. �/ <br />�`r„�--r`_ l l iil�a��� ,._ � I-I'1-/lu <br />