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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9820? <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE 4DDRESS <br />/ SL � ] /a.4 K c�Z S��-'�T <br />LEGAL LOTNO. BLOCK <br />OESC. <br />A�A �2 ��,—�P��s� <br />TENANTNAME <br />PARCE� TAx I.D. t <br />TRACT <br />CONTACTFORPERMIT <br />CONTRACTOR ��,.�JS�1�„1 �JLVn�NLr ADDRESS <br />CONTR. LICENSE N�pg,�, p k 2� z-c y <br />USE OF BUILDING <br />SF� <br />z�3�i0 /LYnf /1�/tf <br />�E <br />HEATSOURCE <br />__ Electric _ Gas _ Other <br />WORK DESCRIPTION <br />/�JSiALL I�•i2E S/�/L�NKLL% <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />9athtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/elc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />_ Grease trap <br />Roof drains <br />Other _ _ <br />PERMIT A <br />'�� <br />PHONE <br />CITYIZIP PHONE <br />/:/1 L/�tJ (�l7N 3 bo -'fo 3 -'�yb � <br />� � N L"�k.-� <br />CONTRACT PRICE OF WORK <br />,3000.�v <br />S �2 <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas f replace <br />Gasranae <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />8oiler <br />Refrigeration <br />Woodstove <br />S/�RI�CL �!Z IICfi(�s <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />I hereby ceritify thal I have read and examined this application and know the same to be true and wrrect. Ail provisions of laws and <br />ordinaces governing �his type of work will be complied with whether specified herein or noL The granting of a permit does not presume <br />to give authority to violale or cancel the provision of any olher state or local law regulatiny construction or the peAormance of <br />construction. That I am authorized by the owner of this property to perform the work for which appliwtion is made and I comply wnh the <br />State CoMractors La 7827 RCW and 29G.200 W�C. <br />�b-�i,�z-(� -� /� � �� <br />