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�RMIT APPLICATI�N <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 <br />SITE ADDRESS n,� � �,(� <br />'�lz�Li �t��Vp f�i%�_ <br />LEGAL ' LOT NO. BLOCK <br />DESC. `"� "��� 1� ��33 <br />PARCEL TAX I.D. # PI:RMIT # <br />GY��{}^%S%53o1_JGb ��/C <br />TRACT <br />[ i/: ('ti`rt' 7l ✓ t—{ <br />i��� ;x v� ��,�,v�,-r; �c ����� S� n.u�;,�J w� <br />� <br />TENANT NAME CONTACT FOR PERMIT <br />�U � �.✓ l��"r7�' .- N_ �2 . �c F itil UC>ort`�0 ��� <br />CONTRACTOR � ADDRESS <br />f i�u ��y�� �Lvf'✓y=-,� � 4{ (��57�'1-�.l�'+�'"� <br />(. c' . ���'� 1� I Z 5 7 L <br />CONTR. LICENSE # �� ,�t �� � cj � Z ,� � <br />USE OF BUILDING <br />�u�� � � ��lJ �o.,� 2- <br />C <br />WORK DESCRIPTION Nr � y��t t� �-�`-� <br />) <br />NO. � TYP[ OF FIXTURE OR ITEM <br />Toilet � �� <br />Balhlub I ! � <br />Lavatory (wash basin) ��' <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />HEATSOURCE <br />Eleclric 1� Gas_Olher <br />NO. <br />�-i2��Zs� ��8 <br />PHONE <br />'-125- Z�2- I `i8 <br />CITY2IP PHONE <br />�-�F f� �'t- �'1� �2.� Z- 1 "(c`� <br />CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas firep�ace <br />Gas range <br />Clothes dryer <br />Range hood //�/ <br />Exhaustfan <br />Heal pump <br />Unit healer <br />Boiler <br />Refrigeretion <br />Woodsto�e <br />CITY OF EVERETT I.00AL SALES TAX CODE IS 3105 <br />I hereby ceritify lhat I havo read and examined lhis applicalion and know lhe same to be true and coRect. All provisions of laws and <br />ordinaces governing this type of �vork will be compliad with whelher specified herein or not. Tho granting ot a pertnit doas not presume <br />to give aulhorily to violate or cancel the provision o( any other slate or local law regulating consWction or lhe performance of <br />conslruction. That I am aulhorized by tho owner ot lhis property to periorm the work tor wh!ch applicalion is made and I comply with the <br />State Contrac�ors Law_78,27-RGW and 29�.200 WAC. <br />�--�-�--� - <br />