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SITE ADDRESS <br />2815 i <br />LEGA LOT NO. <br />DESC. <br />ERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 P�'I� ' D/� <br />425-257-8810 - FAX 425-257-8857 - www.evereriwa.org � _ � <br />APPLICATIONS ARE ACCEPTED FROM 9 AM TO 4 PM <br />BLOCK I TRACT <br />PARCEL TAX I.D. A <br />/ , <br />Nrc x <br />Ib� � % <br />-.•�C' c O� �� w....w� ,� �n � r�ur rnvne <br />L�.J '�� I 1 Z 5 go ST ,.Svu EvEQE'ir �82.a3 <br />TENANT NAME CONTACT FOR PERMIT pF�ONE <br />Ti M S�-�Tt'A CS�c� ��l� - 57�5 <br />CONTRACTOR <br />CONTR. LICENSE t /�� � I� rn, . <br />r <br />USE OF BUILDING <br />ADDRESS <br />53- 970 <br />HEATSOURCE <br />_ ElecMc _ Gas _ Other <br />WORK DESCRIPTION <br />�rT�DiTle�t� � 3 f�3bJt G�R.our.kV <br />�G l St1 *� G��G 1 l� �1''/ <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Waler heater <br />Sink (servfce/badmop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drafn <br />Groase trep <br />Roof drains <br />Other <br />CI?Y21P PHONE <br />CONTRACT PRICE OF WORK <br />� /� • <br />STDRh6rE Tii1,�L,S Tfl <br />NO. � TYPE OF FU(TURE OR ITEM <br />A/C — air handlinp units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas flreplace <br />Gasrange <br />Cbthes dryer <br />Range hood <br />�zhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeratlon <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br />I hereby ceritify that I have read and euamined th:s application and know the same to be frue and cortect. All provlaions of laws and <br />ardinaces goveming this lype ot work wiil be complied wilh whether specified herein or not. The prantlnp of a pertnk does not presune <br />to give authority to violale or cancel the provision of any olher state or bcal law repulatlnp consWctlon or fhe performance of <br />construction. That I am authorized by the owner of this property to perform the work for which epplication is made a�d I mmply wMh tlie <br />State Contractors Law 18.27 RCW�gqd 2,9B.2UO WAC. <br />Y� <br />