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P�RMIT APPLICATIOnI <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 B AM TO 4 PM <br />SITE ADDRE55 <br />�✓�%' /�//t/� <br />LEGAL LOT NO. BLOCK <br />DESC. � <br />PARCEL TAX I.D. A <br />'Z -nn/- noo oon <br />TRACT OR SUBDIVISION M <br />_0�-09 <br />�v�-��r�/��r��v� �'��T�/,e'rr�' .�a ; �o«y,��� ���F�r 9�1�/ %.r3a s'. �i2 / <br />TENANT NAME CONTACT FOR PERMIT PHONE //��� p�� Q/� <br />G y O / Cl <br />5��� �O� y��/ , E-MAIL <br />GONIIfAI:IVK ^""••�"_ �'/�A�� <br />: vE"�f1ov.;/�G s/� 7 l'nC6y�lv� �, .� 9�'Zc�/ <br />CONTR. LICENSE # <br />USE OF BUILDING HEAT SOyRCE I <br />��� _ , <br />Electric �� Gas __ O;her <br />WORK DESCRIPTION/� / <br />���f%/�//��/i���� �.��.�T//v� /`[�/i,�/v�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />BathWb <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposai <br />Dishwasher <br />Clothes washer <br />W ater heater <br />Sink (servicelbar/mop/elcJ <br />Backtlow prevenler <br />Urinal <br />Drinkin� Fountain <br />Floor drain <br />Greasc trap <br />Roof drains <br />Olher <br />�.r-� � �39� <br />CONTRACT PRICE OF WORK <br />9�p � <br />NO. I TYPE OF FIXTURE OR ITEM <br />A!C — air handling unils <br />Forced air syslems <br />Z Gas piping <br />! Water heater <br />Gas firepiace <br />Gas range <br />�Clothes dryer <br />Range hood <br />� Exhaust (an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Waodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify Ihal I have read and examined Ihis application and know lhe same lo be true and correct. All provisions of laws and <br />ordinaces c�overning Ihis type of work will be complied �vith whether specified herein or not. The granling of a permit does not presume <br />b give aulhority lo violate or cancel lhe provision of any other state or local law regulating construction or the p�dormance of <br />conslruction. ��hal I am authorized by lhe owner of Ihis property to peAorm lhe work for which application is made and � comply with the <br />Slate ors La�v 18.27 RCW and 25G.200 WAC. <br />�/� � %D� <br />