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P'�.RMIT APPLICATI(�N <br />CITY uF EVERETT PERMIT SERVICES <br />3200 CED,aR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — ww�v.everettwa.org 5�--�3`� S <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CAROS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # MIT # <br />i Sf i c� � u�-, h� �,� /� l S�S ��lo <br />L0T NO. <br />�/9/7i c <br />TENANTNAME <br />BLOCK I TRACT <br />��n��i� � S <br />CONTRAC70R�Y/�� �{r <br />i <br />CONTR. LICENS'c # �-�G n� <br />L -� <br />USE OF BUILDING <br />/� P S <br />WORK DESCi21PTION <br />CONTACT FOR PERAIIT <br />S/ � �+ ADpRE55 <br />r �5 �rrviYc1nG <br />o y 2 K2 �"o /�v{•-z7 <br />� HEA7SOURCE <br />� Eleclric _ Gas _ Olher <br />�f' ��0�� � ��ii �9U���,�% <br />N0. I TYPE OF FIYTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Lau:: �ry lray <br />Sink (service/badmop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other . <br />NO. <br />yz� — 3Y8'— <br />O fI3 S� <br />PHONE <br />CITY2IP PHONE <br />`�'.Z S - Z > `7— Z ��� <br />s%s� <br />CONTRACT PRICE OF WORK <br />,-- v_-� <br />�.� �Y <br />MECHANICAL <br />TYPE OF FIY.TURE CR ITEM <br />A/C — air handling units <br />rorced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />Other <br />CITY OF EVERETT LOC:.t SALES TAX COAE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be We and correct. All provisions of laws and <br />ordin2ces goveming this type o( werk will be co:nplied wilh whelher specified herein or noL The granting of a permit does not presume <br />to give authority to violate or cancel the provision o( any other slate or local law regulating construction or the performance of <br />construclion. That I am authorized by the own�r o( ihis prop•rty lo perform the work for �vhich application is made and I comply with the <br />Stale Contraclor�Law 18.27 RCW and 296.200 WAC. <br />J "�/,.//� ,� - z� �-r� 5 <br />