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n <br />0 <br />SITE ADDRESS <br />� ��ti <br />L[GAL LOT NO. <br />O[SC. <br />OWN <br />�� y <br />TENANTNAME <br />c <br />2�1� " �c� <br />PERMIT APPLICATION <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 ) p- I?"�D <br />CONTR. LICENSE 11 <br />My�, �o <br />USE OF BUILDING <br />1�'��V <br />�� <br />PARCEL TAX I.D. M PERMIT N <br />I �9oy�Soov;o2`I�� i''llGlv-v�� <br />TRACT OR SUBDIVISION N <br />ADDRESS CITY2IP PHONE c�yy <br />�l('� v�'�S ���i'� `��'z�3 97�-Ss��ir <br />CONTACT FOR PERMIT PHONE <br />WORKDESCRIPTION ��'-r F,. 47'� <br />��,.��--- A...� � U( ba� �. J n <br />NO, I TYPE OF FI%TURE OR ITEM <br />Toilel <br />_ Balhtub <br />_ Lavatory (wa5h basin) <br />Showcr <br />Ki�chen sink R disposal <br />Dishv+asher <br />Clo�hes washcr <br />_�_ Walerheater <br />Sink (servicelbadmop/elc.) <br />Backflow pieventer <br />Urinal <br />Drinkin9 Founlain <br />Flaor drain <br />Grease trap <br />Roo1 drains <br />Olher <br />e�na� <br />g��.,o' ,2�1.,-.,i �, <br />QS SL <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />�� c� <br />_ Eleclric _ �' Gas __ Other �i�� C�v � <br />�`C— L'I"e^SC- f/•'F" G.� C�L�.� <br />MECHANICAL <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 fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust tan <br />Heat pump <br />Unit heater <br />Boiler <br />Ref�igeration <br />W�.�odstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerli(y that I have read and examined this appliwtion and know the same to be true and cevect. All provisions u1 laws and <br />ordinances governing this type of work will be complied with whether specified herein or not. The grenting of a permil does not presume <br />tu give authority to violate or cancel 4ie provision o( any other stale or local law regulating construction or ihe performance of <br />construction. That I am aulhorized by Ihe owner �I this property to perform the work for which application is m�de and I comply with lhe <br />State ContractcyS�aw 1827 RCW and'296200 �NAC. <br />IJ <br />