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PERMIT APPLICATIOiV <br />�ITY OF EVERETT PERMIT SERVICES <br />3200 CE�AR STREET, EVERETT, WA 98201 <br />425-=57-8810 — FAX 425-257-8357 — www.everettwa.org � Z` g, �v <br />APPLICATIQNS ARE ACCEPTED FROM 8 AM TO 4 PM ����2 ���ij <br />SITE ADDRESS�C)/ �j^�D� f� <br />LEGA LOTNO. BLOCK <br />TENANT NAME <br />J��%f <br />Gvn i nM�. � urt <br />l��r �!/dd,f�ni� ,9d;.;i�,��: : -,!/ <br />CONTR. LICENSE # <br />USE OF BUILDING <br />L'/ <br />PAFCEL TAX I.D. # <br />��_- ��,�_ ��n - nnn <br />TRACT OR SUBDIVISION # <br />CONTACT FOR PERMIT <br />ort� /✓�FiC <br />HEAT S(}URCE <br />/ <br />EI@C�!IC V Gas _ Olher <br />/ %� ��a 3.�rZ <br />/�rs���. 6 s 90 <br />E-MAIL <br />:ITY/ZIP P O 'e <br />� CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />���if�,��E�r�o��l F",.C/S%r'�l �G��T//E�.�/ZAT/o�.� <br />NO. I TYPE OF FIXTURE UR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washzr <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease irap <br />Roof drains <br />Other <br />NO. <br />GAL <br />TYPE OF FI%TURE OR ITEM <br />AIC — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas renge <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CI7Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certity ihat I have read and examined this applicalion and know lhe same to be irue and correct. All provisicns of laws and <br />ordinances governing this type of work will be complied with whether specified herein or not. The granling ot a permit does not presume <br />to give auihority to violate or cancel lhe provision of any other state or local law regulating construction or the pertortnance of <br />construction. That I am aulhorized by ihe owner of lhis property lo perform the work for which application is made and I comply with the <br />Slale C ors Law 1827 RCW and 296200 WAC. <br />�%i� .%/' /Z- � �/a <br />