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SITE ADDRESS <br />�1i 1� �1:i <br />LEGA LOT NO. <br />DFSC i <br />� 1�(. /�-n� ivz <br />TENANTNAME <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 96201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE Af:CEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />I`�4�� ���,4� <br />PARCEL TAX I.D. A <br />�` iC•l `.- 1 .� �2�5�- -hC <br />TRACT <br />^�'r�7ititi! �;�Fv� BvS�NC,� ! <br />ADDRESS CITY2 <br />�. Vj/�.L S-G i�y•7.Mli,'�('ll . <br />CONTACT FOR PERMIT <br />0 <br />8�-3i (z�c)�Tj�. <br />PI:JNE <br />�L�G1Snh; ���cfr•ry I:"),�y •,�;f: • (`.,]i:i1'iE"=C i 2c.t. ?�12• C•"i?� <br />CONTRACTOR C'��_' 116 �(��. ADDRESS CITY2IP PHONE <br />� ( J <br />CONTR. UCENSE ft ��, ('G( �_ ) L( .1 �,. (Jj F�7 <br />/ � <br />USE OF BUILDING <br />"l , <br />WORK DESCRIPTION <br />- ii�6�/�r14"`�L (,F-SiA� l'/W j <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 Uay <br />Sink (service/bar/mop/elc.) <br />BackAow preventer <br />Unnal <br />�nnking Fountain <br />Floor drain <br />Grease trap <br />RooF drains <br />Other <br />HEATSOURCE <br />_ Electric ✓ Gas _ Other <br />�._T . lr. � l 711 I f' l� i-,.� <br />NO. I <br />CONTRACT PRICE OF WORK <br />�1� �� �� ��.<< - <br />(�ei.���. l�� i�/. . <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Lehaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodsrove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correcl 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 pertnit does not presume <br />to give authority to violate or cancel the provision of any other state or �ocal law regulaling construction or the perfortnance of <br />construction. That I am aulhorized by Ihe owner of this property to perform the work for which application is made and I wmply with the <br />Stale Contractors Law 1827 RCW and 296200 WAC. <br />Slgnature of Owner/Comractor/Authonzed Agent Date <br />