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�RMIT APPLICATI(�N <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 />SITE ADDRES <br />i 3 ( x �'k��Teu <br />LEGAL LOTN!O� <br />DESC. G <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />B �� . <br />BLOCK <br />PARCEL TAX I.D.1t <br />PERMIT <br />����� � <br />,��� �� S/� d�-�% % <br />CITY2IP PFiONE <br />S-��E ���, o���- . �<<;�-� �-,,,� Y,2t=3�0� �s�� <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />. <br />' . : �. : .i �. .t '�'��-��"i' �c S •, �S =2`�^��'� `.. <br />CONTRACTOR <br />USE OF BUILDING <br />5'�4S� ��ti� <br />WORK DESCRIPTION <br />NC-� St►�GLE <br />/„ ADDRESS <br />(_.(JN�� , ����� <br />t; ••,,1�;_.. <br />CITY2IP <br />' _ '" �,r���� 1 <br />.. r.. . ., <br />.�rLQ L <br />HEAT <br />Electric ,� Gas _ Olher <br />�/.�11L�.�N �9�CAN`r LO I <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet (1�!. <br />Bathlub I I I � <br />Lavatory (wash basin) � � <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washor <br />Water healer <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greaso trap <br />Roof drains <br />Other <br />;L�1 <br />PHONE CBC/�( O ^ <br />(.�i���� ��-'lb��( <br />CONTRACT <br />'S'a0 o0U <br />TYPE OF FIXTURE 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 />Clolhes dryer <br />Range hood � / <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler � <br />Refrigeration (/Ji�-�' �' �" � <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />OF WORK <br />`iF <br />I hereby cerilify Ihal I have read and examined this applicalion and know the samo to be true and correcl. All provisions of laws and <br />ordinaces �oveming this lype o( work will be complied wilh whelher specified herein or not. The granling of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or Iocai law regulating construction or the perfortnance of <br />construction. That I am authorized by the owner of lhis property to peAorm the work for which application is made and I comply with the <br />Stale CoNractors Law 18.27 RCW and 296.200 WAC. <br />`��� 6Cri 2,;r y� � ��i <br />