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SITE ADDRESS <br />l0T NO. <br />DESC. <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8657 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOClC I TRACT <br />PARCEL TAX I.D. # <br />MIT N <br />?oS-�-! <br />TE,��� KriOHAEL- �/$0� H�eou,� LN, Ev% �jQ�a3 Y25-3�17-.3�{97 <br />TENANTNAME CONTACTFORPERMIT PHONE <br />BF'-Y�� ��'1-��r- �{z�r775-�0 ��o y <br />CONiRACTOR ADDRESS CITY2IP PHONE <br />Df+vd-N�r� /��,�,��- d-ff-,v-, iU�i� i.3,� A�. �.�/. �yNc,�wo�o �zs-ns-���N <br />CONTR. LICENSE �*A"�i/�SI%I'f O �i'I C���L �o�J � <br />1J <br />USE OF BUtLDING � HEAT SOURCE I CONTRACT PRICE OF WORK <br />WORK DESCRINTfON <br />/P�P�RcF <br />OU7-5/Q � <br />PrP�n� G-, <br />NO. I T'PE OF FIXiURE OR ITEM <br />TOile.l <br />Balhlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />D{ shwasher <br />Clolhes washer <br />Walcr h�aler <br />Sink (service/bar/mop/elc.) <br />Back(low preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />_ Electric }1 Gas _ Other I � c7C�/ �� <br />�C�? FT cF Exrsn+�Cr- Cri1s i�IP�,-CT �N <br />O� /7z'�.;5� (it//77-( hJ�2.�,tJ lj'�¢$ <br />NO. I TYPE OF FIXTURE OR ITEM <br />fVC — air handling unils <br />Forced air syslems <br />� Gas piping <br />Water healer <br />Gas firepiace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby ceriti(y that I have rcad and examined this application and know lhe same to be true and correct. All provisions of laws and <br />ordinaces goveming this lype of work will be complied with whether specified herein or not The granting of a permit does nol presume <br />to give aulhonry to vielate or cancel the provision of any olher s:ale or local law regulating conslruction or the perfortnance of <br />cunstruction. Thal I am a�thorized by lhe owner of Ihis property to perform lhe work for which 2ppliwtion is made and I compiy wilh the <br />Slale Cgnlrq�ctors Law 16.27 IjC�W and . 0 WAC. <br />��'-i.�� _ � � J . .� = /l—U7 <br />