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PEh�'JIIT APFLICATIOh <br />CITY OF EVERETT PERMIT SERViCES <br />3200 CEDAR STREFT, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.e�•arettwa.or9 � d- a G-o {� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPFEQ <br />SITE ADDRESS , PARCEL TA7( I.D. # RMI # <br />���� ' � ���.So �t�1�'DDuS 6 0�� 0'- <br />L-0 �- �•�, e ZG <br />LEGAL _LU7N0. OLOCK TRACT RFjt 0.7`�%jAN� ��� •� � �� �'� �°� ' C�r •S;, <br />�� <br />TENANTNAME <br />CONTRACTOR � �� � � � <br />CONTR. UCENSE �i <br />I W� �2t� (: � E,fo E. LN c�' SC.; <br />ADDRE55 CINIZIP <br />'_�it'';i �` ��` 14r-�niE;'!�l �veo�,T/ <br />CONTACT FOR PERMIT <br />� ADDRE55 CIN21P <br />� r<��{«��.i <br />;�(��l'�C. e�� C�,��<`�'��- <br />USE OF BUILDING <br />�l � ;' <br />�r��a_ � r,+i�� _y<,, �- <br />WORr('iESCRIPTION " <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balh�ub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & dispasal <br />Dishwasher <br />Clathes washer <br />Laundry lr2y <br />Sink (service/6ar/mop/elc.) <br />Back(low preventer <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grease trap <br />� Roof drains <br />Other <br />HEATSOURCE <br />� Eleclric _ Gas _ Olher <br />�.�.�"..�/� i�.�8� <br />PHONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />NO. TYPE OF FIXTURE OR ITEM <br />A C— air handling units <br />Fo.ced air systems <br />Gas pi, ing <br />Waler neater <br />Gas Lreplaee <br />3as range <br />Clothes dryer <br />Range I�ood <br />Exhausl (an <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />CITY OF EVERETT LOCAL 3ALES TAX CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this application and know lhe same to be true and correct. All provisions of la�is and <br />ordinaces governing Ihis type o� work will be compi�o� ::�th whether specified herein or nol. The granling of a permil does not presume <br />to give authonty to violate or cancel the prcvisicn oF any o•:hr,r state or local law re�gulalinc� consWction or liie performance of <br />con�truction. That I am authorized by lhe owr.er of this propedy lo pedorm the work for which application is made and I comply with the <br />Slale o,ntractors La 1.27 kCW and 24�.�00 WAC. <br />/�" . �L�2 �%�. /���7'.�Z�71.' cl `cit"`, / ` � � - _��_� <br />Signature of Ow edContractor/Aulhonzed Agent Date I <br />� L <br />