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P�rtMIT APPLICATIC��� <br />�ITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-�810 — FAX 425-257-8857 — www.everethva.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT C1RDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />�-i� t� 21 C7 r e. e, ` S� <br />LEGA LOT NO. BL CK <br />DES0. �3_�g �� <br />�.�.a.-\�.z -�� Sh0.�o., <br />TENANTNAME <br />�Y�a.-`2> \V 0.mXS <br />CONTRACTOR <br />p vJ .� ¢, r <br />CONTR. LICENSE / <br />USE OF BUILDING <br />TRACT <br />� a-•. k s <br />PARCEL TAX I.D. N <br />�-4c� z.� Grt�.l <br />ICONTAC7 FOR PERMIT <br />ADORESS <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />WORK DESCRIPTION <br />� Jv�,� T �ccm Q-�ac.�c: c � � �CS <br />NO. I TYPE OF FIX7URE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Foun4-+in <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />F.v� <br />f <br />yzs-3ss-�yz� <br />PHONE <br />CITY2IP PHONE <br />� CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE JR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unft heater <br />Boiler <br />Refigeration <br />Woadstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7A% CODE IS 3105 <br />I hereby ceritify that I have read and examined lhis applicadon and know the same to be tr�e and corred. All provisiona of lews and <br />ordinaces governing this type of work will be complied with whether specified herein or not The grantlng of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating constructlon or the perfortnance of <br />construction. That I a�n authorized by the owner of this property to perform the work for which a^�licatlon is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />� a r � -� � n,�,Q.i,J �c � 2 \ � U �-k <br />