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P`�RMIT APPLICATIt,N <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 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />LOT N0. <br />BLOCK <br />TRACT <br />PARCEL TAX I.D. # <br />n <br />PERMIT # <br />MoS t �-oa5 <br />_...._.. LK srt"ve,✓5 y25'3�7-q'333 <br />%i1�-n� V� L�u v�� IIOaO ri1:�n�� LN, 9�a5$ <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />�IAC� i �^� i�L I 8/'�-�r,4� �Avc�-�� y25-��5 �yl��i <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />D<iytNl� �tac�r�G�r�b-d'ftT6-. IG�(cIN 1.3,'�A'b�U1- LY�/Nc�Dv� yZ5.�%5���/l�y <br />CONTR. LICENSE# ��yNl ^�DY�CIyL ��� / <br />Y <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />_ E�ectric � Gas _ Other � 98�2'�� <br />WORK DESCRIPTION <br />�EP�RcC Cx���n�C� GR5 <br />��.rr�i.{rF� .�QmJ�� �ZrrnoY�2 <br />fh✓o /'EntAcE u1��rN Necv. <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry lray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />,Fu�=,��-�� u/�T7t Necu G-f-s <br />,�c� Ex�sn�c- Dcccr cuv��< <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handlinc� units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />'^ qive authority to violate or cancel the provision of any olher state or local law regulating construction or the perfortnance of <br />struction. That I am authorized by the owner ot this property to perform the �vork for which application is made and I comply with the <br />..,ate Contr yto�sAa^v 18.27���AC. <br />/I 3 -o.� <br />