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PEi�MIT APPLICATIOM <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 />SITE ADDRESS <br />6 2s I-� J a, <br />LEGAL LOT N0. <br />oEs�. z <br />OWNER <br />0 �/�,�� coh�-a���, . <br />TENANTNAME <br />vacG„+ /4„d <br />CONTRACTOR <br />Sam� as �p�,Cv <br />CONTR. LICENSE # <br />O,t/F tL C c <br />USE OF BUILDING <br />��S �G�c+, � ra � <br />WORK DESCRIPTION <br />APPLICATIONS ARE ACCE PTED FROM 8 AM TO 4 PM <br />PARI:EL TAX I.D. # <br />(�i-r�,.� JU5 �' 176J�0 /102 <br />BLOCK TRACT <br />s .� ',�—�:;-oY <br />ADDRESS CIT <br />� lC�� c�.,�, <br />n� Cont�n.��f/o�y I„�, Ev. e w� <br />ICONTACT FOR PERMIT <br />.f os�i � ti •� l <br />NO. I TIPE OF FIXTURE OR ITEM <br />Toilol <br />Balhlub <br />Lavatory (w2sh basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflo�v prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease Uap <br />Roo( drains <br />Olher <br />AODRESS <br />HEAT SOURCE <br />Eleclric X Gas _ Other <br />�?�r,� /1Z <br />�� <br />S� c - <br />�s� y yas <br />PHONE <br />yzr .s <br />CITY2IP PHONE <br />CONTRACT PRICE OF WORK <br />120�°00� //_'7 �Q� <br />NO. � TYpE OF FIXTURE OR ITEM <br />A/c; — air handling unils <br />Forced air systems <br />Gaspiping co„n«F�;,,f <br />Waler healer <br />Gas (ireplace <br />Gas ranc�e <br />Clothes dryer <br />Range hood <br />Ezhauslfan <br />Heal pump <br />Unit heater <br />F�iler <br />Refrigeralion <br />Woodstave <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that t have read and examined this applicalion and know Ihe same lo be We and corcecL All provisions of laws and <br />ordinaces goveminc� ihis lype o( work will be compliod �vith whether specified herein or not. The granting of a permit does nol presume <br />lo give aulhority to violale or cancel ihe provision of any other state or local law regulating construclion or the performance of <br />conslruction. Thal I am aulhorized by the owner of this property to peAorm the work for which application is made and I wmply with the <br />Slale Conlractors Law 18.27 RCW and 296.200 WAC. <br />i��� <_� /� � <br />I �2 <br />