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PtRMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICE� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8E57 �- www.everettwa.org <br />APPLICATIONS ARE ACCEPTEI) FROM 8 AM TO 4 PM <br />SITE ADDRESS�� 3d , / // <br />— �/ <br />BLOCK <br />....� <br />r� t..a / ./t%[.✓ /�G' .�/ C/ �_ <br />TENANTNAME / <br />QC� C ...� '�"'�e n�• <br />CONTRACTOR <br />CONTR. LICENSE # OGvN� / <br />/`. <br />USE OF BUILDING <br />�� z���� <br />WORK DESCRIPTION <br />PARCEI T!U' I.q. # <br />TRACT <br />AODRESS CITY21 <br />� G✓���..L .z5 ii ; <br />CONTACT FOR PERMIT <br />ADDRESS <br />HEAT SOURCE <br />_ Eiectric _ Gas _ Other <br />/ <br />�� z �-i s � � �.� �,.� <br />2��..�5 G� � .F .�e..., 5-�Cf:/ <br />NO. I TYPE OF FIXTURE OR ITEM <br />Tailet <br />_ Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Olher <br />CITY2IP <br />PERMIT # <br />Bo�c�� - <br />PHONE <br />�,/�„ y �'/ <br />PHONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />Zo, �co <br />i2� // c. .o <br />. <br />�/� �p /l'� /�J, <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />_ Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Ctothos dryor <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodslove <br />CITY OF EVERETT LOCAL SALES T/V( CODE IS 3105 <br />I hereby ceritify tlial I have read and examined this applicalion and know the same to be lrue and corcecl. AII provisions of laws and <br />ordinaces governing lhis type of work will be complied with whether specified herein or not. The granling of a permit does nol presume <br />lo give authonly to violate or cancel the provision of any other state or local law regulating construclion or the peAormance of <br />constr ' i h�'eni authorized y the owner of lhis property to perform tjye worl�for which applicalion is made and I comply with the <br />St C �s Law 8.2 IN'and 296.200 WAC. / / <br />