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i <br />PtRMIT APPLICATION <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 8 AM TO 4 PM <br />SITE ADDRESS <br />i i � � �� C� QOU �G <br />PARCEL TAX I.D, p <br />bUS494 on(�.�qco <br />LOT NO. BLOCK TRA/C�T /� <br />�����Z� �o '�CUt'CN /,1NNc IQoi]'�i <br />���,�Y �r��t-� ��S�s !J_ L.aK�sNcn.�- A�= La�avavetis ����� <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />CONTRACTOR %�qG��C C�A.�} <br />CONTR. LICENSE # �7�, FG,/ 6 p, JLz S/`% <br />USE OF BUILDING <br />�.4G�A-E-C•s' <br />WORK DESCRIPTION <br />An� A ? ? f= �� � --:�a�� <br />NU. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />_ Shower <br />Kilchen sink 8 dispos: <br />Dishwasher <br />Clothes washer <br />Waler healer <br />_ Sink (service/b /mop <br />_ Backflow prev nter <br />_ Urinal <br />Drinking F ntain <br />Floor drai <br />Grease ap <br />Roo( d ins <br />Olher <br />ADDRE3S Z-� �(o ,E���r�Z CITY2IP ' PHONE �/ Zf ZS�?-� 3// <br />� t�Y�T G ` �i <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Electric _ Gas _ Olher Z S, �`• �-�' <br />� �n..r�n-T pr h'�STj.�L %?��G <br />NO. I TYPE OF FIXTURE <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />_ Waterheater / <br />_ Gasfreplace � <br />_ Gas range � <br />Clothes dryer <br />Range hood <br />Exhausttan <br />_ Heat pump <br />Unit heat r <br />Boiler , <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby ceritily Ihat I have read and examined lhis application and know lhe same to be lrue and correct. All provisions of laws and <br />ordinaces �overning Ihis lype of ��ork will be complied with whether specified herein or not. The granling of a pertnit does not presume <br />to give authority lo violale or cancel lhe provision of any other state or local law regulatirg construction or the perfortnance ot <br />construction. Thal i authorized by lhe owner of lhis property to perform the work for which applicalion is made and I comply wilh the <br />State Contrecl Law �CW a 296.200 WAC. <br />i����� 3/,3 /�ti _ <br />SignaWre'o( OwnedContractodAuthonzed Agenl Date �� <br />