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P��ZMIT APPLICA'Tld��l <br />CITY OF EVERETT PERMIT SERVIC;ES <br />3200 CEDAR STREET, EVERETT, WA 982U1 . <br />525-257-8810 — FAX 425-257-8857 — www.everettwa.org � � �� ,// _ <br />rp <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />�O�o3 <br />LEGA LOT NO. <br />DESC. Z <br />�Lak��r�r� <br />TENANTNAME <br />o ti ,. � <br />BLOCK <br />% <br />PARCEL TAX I.D. # <br />� � �n,���-� -��. �, <br />TRACT (yl-[y OF E�c�� <br />leqn c Nu TNT�C i� y <br />�iow�Ei lnc� Ro, 3c�x 8'i� <br />CONTACT FOR PERMIT <br />S�-rev� luv�,-eg� 5 <br />CONTRACTOR �KC�nlp �,�n+Ej �r�• ADDRESS <br />CONTR.LICENSE# LY-1KE�—��I. Oo I SL <br />USE OF BUILDING <br />�1'✓�. '�l/0 � <br />WORK DESCRIPTION N�IJ <br />� �,'� c� / <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Cbthes washer <br />Laundry tray <br />Sfnk (service/bar/mopletc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ Electric 7� Gas __ Other <br /># <br />��I <br />���rs�onl �"Z, �13 , �3Z <br />CITY2IP PHONE <br />�-k S-nuerl5 ��5 ° <br />PHONE <br />�(zs- 3S�-���� <br />CITY2IP PHONE <br />w/ vNFi,v�.r�q ,�as�.�k�rr' <br />� !�i o l� � ,,� <br />CONTRACT PRICE OF WORK <br />N0. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas flreplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeratlon <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br />I hereby ceriti(y that I have read and examined this applicaUon and know the same lo be true and correcL All provisions of laws and <br />ordinaces goveming this type of work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />to give authonty to violate or cancel the provision of any other state or local law regulating consVuction or the perFormance of <br />construction. That I am authorized by the owner of this property to perform the work for which appiicatlon is made and I wmply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />o�� 5 <br />Date �� <br />