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SITE ADDRESS <br />�36 <br />LEGA LOT NO. <br />TENANTNAME <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETi, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�oC'US T <br />BLOCK <br />PARCEL TAX I.D. # <br />� .�9Z --00% o d o <br />TRACT <br />ADDRESS <br />07 CoCB�.�t�E' �7/E, <br />CONTACT FOR PERMIT <br />`J-`,_o`I <br />PERMI_� <br />PNONE <br />y�.r3a.�. i� <br />PHONE <br />SH/'�� ��o�/ ir/�f'F� S�Z.s-So� 6390 <br />CONTRACTOR �/�� ,i�f�NG ADDRESS CITY2IP PHONE <br />� �� �� 3k�� �a�y,,��- ��-n 9��� <br />CONTR. LICENSE # �/iI,/r� G� /�/)b <br />G JW d 7 <br />L�SE OF BUILDING <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Eleclric ✓ Gas _ Other 'Y 9Q(J, � <br />WORK DESCRIP'fION <br />,P��A/,E�E'/9vGE'L .F.r/Sfir��G •lE".f��E`N�t <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposa� <br />Dishwasher <br />Cblhes washer <br />Waten c�alor <br />Sink (servicelbadmop/etc.) <br />8ackflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />NO. <br />TYPE OF FUCTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeralion <br />Woodslove <br />O!her <br />CITY OF EYERETT LOCAL SALES TAX CODE IS �105 <br />I hereby ceriti(y that I have read and examined this application and kno�,: the same to 6e lrue and cortect. All provisions ot laws and <br />ordinaces governing lhis type of work will be complied with whethor specified herein or not. The granting oi a pertnit does not presume <br />to give authority to violate or cancei the provision of any otY�er state or local law regulaling wnsWcSon or the perfortnance of <br />conslruction. That I am authorized by the owner of this property to perform the work for which application is made and i comply wilh the <br />State Co rs Law 1827 RCW and 296.200 WAC. <br />,�G�✓� �9-a9 <br />