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PEIC��AIT APPLICATIOI�i <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 />3 � 7 --c9 (o <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 3 CREDR CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />LOT NO. <br />�CO�'3 �e�; <br />BLOCK <br />� <br />PARCEL TAX I.D. A <br />I r I i KP � I�� 5 0� y C..t�_ �-IN Hcac� t l��- y <br />TENANT NAME � CONTACT FOR aFa�ir pHON� <br />���_ I �AN �YiANty � ���3-!>I <br />CONTRACTOR �'v���� �U���ga�` cm ����� <br />a�818 �3 <br />CONTR. UCENSE X � , .� ,� ,�,., � �., , ;�, , /1 n �,. i.,�_ � i l � �r-� n�. <br />USE OF BUILDING <br />r.�r•1�� <br />NO. <br />Toitet <br />alhtuh <br />La tor <br />Show <br />Kitchen <br />2 Cfl��A'�A�� <br />TYPE OF FIXTURE OR ITEM <br />(wash basin) <br />& disposal <br />Clothes washer\ <br />Laundry tray <br />Sink (servicelbar/m <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease tra <br />Roof dr s <br />HEAT SOU E � <br />Gas _ er <br />NO. <br />� <br />7!6 I <br />CONTRACT PRICE OF WORK <br />��3, 10�. � <br />��9,�v" <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced alr systems <br />C�as pipfng <br />Wi�er heater <br />Gas ra <br />Clothes d <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unk heater <br />Boiler � <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />1 hereby ceritify that I have read and examined this applicaGon and know the same to be true and cortect. All provisior.s of levra and <br />ordina vemi is po of work will be complied with whether specifled herein or not. The granting of a permft doea nol presume <br />to ' e autho t violate r cancel the provision af any other state or local law reyulatlng conshuctlon or the performance of <br />nstruction. T t m au horized by the owner of this property to perform the work for which applicaUon is made and I comply wiM the <br />tate Conlract La 18.27 RCW and 296.200 WAC. <br />�IZ <br />