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PEKMIT APPLICATION <br />CITY OF EVERETT PEi�MIT S�RVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 -- FA?: 425-257-8857 - www.everette�a.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS ,� <br />�D c luu ✓-E' � �/ <br />LOT NO. � BLOCK <br />- �t���V-'� �� (il�-et � <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />PARCEL TAX I.D. # <br />TRACT <br />�02 l�� u,,, e / � r <br />CONTACT FOR PERMIT <br />ADDRESS <br />� 2- a a..-C?.� <br />RMIT # <br />!v/� - o// <br />,�l/E'✓-c-1,-� -�l.f�iZUl �/�S,'/�'8is. <br />PHONE <br />CITY/ZIP PI10NE <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric Gas Other <br />WUK�n4��' LirliO�CC SL.C.:t%�I� Il N•� CfK/X GTPGC�N-� 7"'�ji/✓� ��G�iul��• // V'-'_ <br />�� r�l t <br />� �� v <br />K'Cc�Zaioe3ln W- �uG6l�lF��`� V� <br />�/ <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwashcr <br />Clolhes �vasher <br />Wa�en c�aler <br />Sink (service/badmoa/elc.) <br />Backflow preventer <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grease lrap <br />Root drains <br />Other <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Wa!er heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Ran9e hood <br />Exhauslfan <br />Heal pump <br />Unit healer <br />Boiler <br />Rsfrigeration <br />Woodstove <br />CIN OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />I hereby ceritify thal I have read and examined this application and know the same to be true and correcl. All provisions of laws and <br />ordinaces c�overning Ihis type of work will be complied wilh whelher specitiad herein or nol The granling of a permit does nol presume <br />to give authoriry tu violate or cancel the provision of any olher state or local law regulating conslruciion or Ihe per(ormance ot <br />construclion. That I am aulhori ed�by the otvner o( this property to perform the work for which application is made �nd 1 comply wilh the <br />Stale i.6nlP,jctors La�v 18.27 R� �qd 2962Q�JAC. <br />/ J �� I � I/ I <br />217-L/1) b <br />