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P�RMIT APPLICATI�IV <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREEI, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />SITE ADDRESS <br />3n/ h�A�,�.'se�-� <br />LEGAL LOT NO. BLOCK <br />OESC. r� `7 ����I <br />OWNER ,� / <br />I `�-o�tn R-`5 W �� ���Y1 S9-��l <br />TENANTNAME I <br />5,4-,-�-- � <br />CONTR. LICENSE N <br />USE OF BUILDING <br />WORK DESCRIPTION <br />A-oA Z s i-o,� y <br />NO. I TYPE OF FIXTVRE OR ITEM <br />—�j TOiICI <br />/ 6alhlub <br />� Lavalory (wash basin) <br />_ Shower <br />Kdchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />SinY. (sr.rvicelbadmop/elc.) <br />f3ar.kllow prevcnlr.r <br />Urinal <br />Drink�ng Foun�ain <br />Floor drain <br />� Greasc Irap <br />_ Roof drains <br />Othr.r <br />PARCEL TAX I.D. # <br />O� (oOZ Nf�O <br />TRACT OR SUBDIVISION k <br />z 3 �r h��.��,� � <br />CONTACT FOR PERMIT <br />�m G�%��e�hSA� <br />?3ii �y�.�r�s,,,. <br />,�- ��c%� F � <br />HEAT SOURCE <br />_ [lectric _ Gas <br />� r <br />�ag -d°1 <br />a <br />� —Qz�1 <br />� ��',�a �i 1a��' <br />PHONE?�q�' 7q�- L�ZZO <br />All �OM � <br />Ei/Prr/� • 4/,� <br />Other <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR �TEM <br />� <br />AIC - air handliny uni�s <br />ForCed air systems <br />Gas piping <br />Waler healer <br />Gas li�cplace <br />Gas ran�e <br />Cblhes Jryer <br />Ra�ge hood <br />[«hausl lan <br />Haal pump <br />Unil hcater <br />f3oil�:r <br />Relrigeratwn <br />Woodslove <br />Other_��nc�� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />i <br />I hereby centity �hal I have read and examined Ihis application and know Ihe same to be Irue and correcl. NI prowsions of laws and <br />orAinaces ,yoveminy Ihis type of work wlll be complieA wilh whether specilied herein or no1. ihe yranting o( a permil does not presume <br />to give authority to violale or cancel the provision of any olter state or local law regulatin� ronstruction or ihc pertormance o( <br />consiruclion. Thal I am authonzed by Ihe owner ol ihis property to perform the work (or which applica6on is made and I comply wilh �he <br />Stalc Co ors Law 1fi 27 RCW and 296200 WAC. <br />��rn Gr/.,c�/�-�,-r.�o-- �u�ri � —�'l <br />SignaWre ol OwnedContraclor/nulhorrzed �gent / uaie <br />,r / / / ��z <br />ID/N�iI/�(�Sp/� ' R�Y�IOd i�7Pt7 iQ9FM I` <br />� � <br />