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SITE ADDRESS <br />LOT NO. <br />PtRMIT APPLICATIVN �--�g'0� <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 ��U� �I � <br />BLOCK I TRACT <br />PARCEL TAX I.D. # <br />?4 � Y e-n �- �- e <br />TENANT NAME CONTACT FGR PE�:C.7ii <br />•5�-4Y(_.r! Nc�i(_3�SPF� NS��#�-- <br />PNONE <br />�/ <br />CONTRACTOR ��,��5 Q� Uw�v�l i1 � ADDRESS �7��� �1-{tll _l, nv� �?IP��PHONE L����5'� <br />I �LYn � �(1$� <br />CONTR. UCENSE # � µ`' p � � `{� � � I � P <br />f— 71' <br />USE OF BUILDING � HEAT SOURCE I CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />� Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />1 Cblhes washer <br />�_ Waler healer <br />Sink (servicelbadmop/etc.) <br />Back(Iow prevenler <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />_(_ Olh o Si <br />—�— <br />I_ Eleciric �Gas _ Other <br />SP� -a f�Q��L <br />NO. I <br />, cR-C.� <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplaco <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <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 lhis app�ication and know the same to be We and correcL All provisions of Iaws and <br />ordinaces goveming this type of work will be complied with whether specified herein or nol. The granling of a permit does not presume <br />to gi�re authoriry lo violale or cancel the provision of any other slale or �ocal law regulating consWction or lhe performance of <br />cons�ruction. Th�l I am authorized by lhe owner of this properly lo pertorm the work tor which applicalion is made and I comp�y with lhe <br />State Cor,tractp� Law 18.27 RCW and 29fi.200 WAC. <br />/�,-l�cc;�,�. �—.7-9�C�-6 <br />