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C <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />32C0 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />SITE ADDRESS <br />�7tiz� r��.�l�:sc�.i <br />LEGA_ LOT NO. <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />r✓e�t i l pqRCEL TAX I.D. # <br />,c��/- y�z��:i.2�o�1�-�Zoo-�� . <br />BLOCK TRACT <br />� <br />kyL)/�lir S/��N ji�✓��i INtTllt - Z�,L0�3 j�. }�y' .��y.•iN>AJni�+}� 201i-y6�-37c^�1 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />t,LZ�/ t� �,r,�t.�c.._ ,;4n. 71 7- c yo y <br />CONTRACTOR ADDRESS . CITY/ZIP PHONE <br />(�F�-1 vN�-z�.IMi�c.hL �1it I�ct� r�:.�ut ��.a.clin��.:..i�`/�23�- 3�v0-7�7-4•S< <br />CONTR. LICENSE # �^� . -? - l C� _ [� (J <br />/ <br />USE OF BUILDING <br />Q.2 T�i � �- <br />WORK DESCRIPTIQN <br />rz�,��„ ,� , �,�,�.. n��.,.ti,.., <br />%�lj L ili r:-i � 4- iJ �,V i 1— <br />NO. I TYPE OF FIXTURE OR ITEM <br />t1 Toilel <br />� Bathtu� <br />� Lavatory (�vash basin) <br />Shower <br />Kitchen sinh & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry Iray <br />Sink (service/bar/mopfetc.) <br />Back(low prevenler <br />Urinal <br />Drirking Founlain <br />� Floor drain <br />Grease trap <br />Roo( drains <br />Other <br />HEATSOURCE <br />_ Eleclric _ Gas _ OOier <br />CONTRA� T PRICE OF WORK <br />77-i iiti ..._ <br />-1,..._ �1 C �2f-'a; �Zur..u��_ u,v/�/ <br />� <br />L��,^n�-� L iN t�.a.,o � ���: ,�.i�-S , 7� �.���a�; �.C._ <br />uC.a <br />� <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater —�,.� Ji•�.r•"•(- u� c(..� <br />Gas (ireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Ezhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Reiri�eralion <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX GODE IS 9105 <br />I hereby ceritify thal I have read and examined lhis application and know lhe same to be Iru� and correcl. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether speci(ied herein or noL The 9ranting of a permit does nol presume <br />to give aulhority to violate or cancel lho provision of any other slate or local law regulating construclion or the pedormance o( <br />conslruclion. T,F�aI I am authorized by the owner o( this property lo perform Ihe work for which application is made and I comply with the <br />State Contr ��rs Law 18.27 RCW and 296.200 WAC. <br />�Y �_.6'U .� <br />SignaWre of OwnedContractodAuthorized Agenl Date <br />