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SITE ADDRESS <br />LEGAL �LOT NO. <br />OESC. Ig- �c � <br />PtkMIT APPLICATI(�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERF_TT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />30 <br />PARCEL TAX I.D. # <br />0 0-� 3,4.s3 3n stn iy-ov <br />TRACT OR SUBDIVISION # <br />,� `�69�G� <br />'O�-O/Z <br />F;•�ti� � Sleu/oc�c /S29 �i�iNrri�? /y��� 9glo� �,Zr•,Zs,�-�-8� <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />Q 4�1� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />l� /��'. <br />WURK DESCRIPT�ON <br />NG <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />6alhlub <br />Lavatory (wash basin) <br />Showcr <br />Kilchen sink 8 disposal <br />Dislnvasher <br />Clolhes washer <br />Wa1er heater <br />Sink (servicelbadmop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greaso lrap <br />Roof drains <br />Other <br />HEAT SOURCE <br />Electric _ Gas _ Other <br />� <br />CONTRACT PRICE OF WORK <br />,�,��9 o�y <br />TYPE OF FIXTURE OR ITEM <br />NC — air Landliny miils <br />Forced air systems <br />Gas piping <br />Walcn c�atcr <br />Gas firep�ace <br />Gas range <br />Clolhes dryer <br />Ran�e hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby ceritify thal 1 have read and examined this applicalion and know Ihe same to be true and correct. A�I provisions of laws and <br />ordinaces goveming this type of work will be complied wilh whether speci(ied herein or noL The grantinc� of a permit does not presume <br />to give authority lo violale or cancel lhe provision of any olher state or local law regu�alinc� consWclion or the pedormance oi <br />construction. l hal I am aulhorized by the owner of this property to perform the work for which application is made and I comply wilh the <br />State Coptraclors Law 18.27 RCW and 296.200 WAC. G <br />� J= n /'1�—� ( <br />(/,y7 L:`�,�.-�� C/ — � <br />Sic�nature of Owne7Conlractor/Aulhorized Agent Dale I�� <br />;� <br />