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3Y� <br />P�RMIT APPLICATI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br />'3 Lvcv�S; <br />LOT NO. BLOCK <br />� /�u.f/NG ,3/U% <br />TENANTNAME <br />.�9iy� <br />�/NT A�tR�!%�/NG A�/l7��lTy <br />C/ // //� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />,5�� <br />PARCEL TAX I.D. � <br />S/.�2-o%�o-aao <br />TRACT <br />ADDRESS CITY/ZIF <br />4yA�E- �,��9� <br />CONTACT FOR PERMIT <br />ADDRESS <br />— HEAT SO}1RCE <br />Electric � Gas Other <br />PERMIT # <br />� �D��d3a <br />PS�Zr�'' �r2i <br />PHONE <br />/2.�-so�' 6390 <br />CITY2IP PHONE <br />ICONTRACT PRICE OF WORK <br />� ,�i � <br />WORK DESCRIPTION <br />�P.F�.9/��,1�/Y�� �•�.f7/Nl ��f/G��/lE� <br />NO. I TYPE OF FU(TURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease Vap <br />Roof dralns <br />Other <br />NO. I TYPE OF FDCTURE OR ITEM <br />A/C — air handling units <br />Forced alr systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Cblhes dryer <br />Rangehood <br />Exhaustfan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provfsions of laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or not. The granting of a pertnil does not presume <br />to give authority to violate or cancel lhe provision of any other state or local law regulating construction or the perfortnance of <br />construction. That I am aulhorized by the owner of this property to perform ihe work for which applicalion is made and I comply with the <br />Slate Co s 1,�� 18.27 RCW and 296.200 WAC. <br />/ %7�-op <br />