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PEKMIT 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 ACCtPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />_, y�,3 w M��; /�°o c�l vGf' <br />LEGAL LOT NO. BLOCK <br />DESC. a DO O <br />PARCEL TAX I.D. # <br />GdSoS-r�oOOn��O 6 <br />TRACT /� <br />�%4o�P rTPiG <br />/2 3� -�(o <br />v�m�rt NUYRCJJ a.iinur rnvnc ,as- 4 <br />5� a6o <br />�r�.P S,,.is/-�1�- 2`{��g w/'u.�c,FF�, �(v�Q G�er�h- l.�/� 98d��3 z822. <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />�Yr� Sl.�.�rSts-'f' `idS=�6S 1�21 <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />CONTR. LICENS:: p <br />USE OF BUILDING <br />Si�/p�milr.J l?a�.��'Tt. �l <br />HEATSOURCE <br />_ Eleciric �Gas _ Other <br />WORK DESCRIPTION ,. , . ., _ _ <br />c .. � � �'l1l U C���1/i.c�—� F' <br />rr <br />.., <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washcr <br />Waler hoatcr <br />Sink (service/bar/mop/etc.) <br />Backflow prevenlcr <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olho� <br />CONTRACT PRICE OF WORK <br />;r- vfFa�w�9`'�`�P <br />. o�� ��r-. ox �,vs.� 2st <br />2/.�. S J� .-a V <br />NO. � TYPE OF FU(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 />Cbthes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unil heater <br />Boiler <br />Re(rigeration <br />Woodstove <br />Olher �h�nQ ,_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� hereby ceritify ihat I have read and examined this application and know the samo to be true and correct. All provisions of laws and <br />ordinaces governing lhis lype of work will be complied with whelher specified herein or nol. The granting of a permil does nol presume <br />lo �ive aulhority to violale or cancel lhe provislon of any olher stale or local law regulaling consWclion or lhe periormance of <br />construclion. Thal I am aulhorized by lhe owner of this property to pertorm lhe work for which application is made and I comply wilh the <br />Stale Coniracter�-aw-i�2ZRCW and 296.200 WAC. <br />