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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 <br />SITE ADDRESS PARCEL TAX I.D. # <br />.3'-1 t O W t�tl,ul� t�Tt�o i�� p. �� 5 7 l � �c>y o �? a o <br />LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br />DESC. ^? <br />OWNER AODRESS CITY2IF <br />�l�i/,Ltit �SU�2l�l� 3���0 l� �ul�(Ll�-T1�0 [3(. <br />TENANT NAME CONTACT FOR PERMIT <br />/ �►iut� Prt��.s�.Tl <br />LUfVIKAI:IVK �\Jn u�y� <br />��t ic � 7 <br />CONTR. LICENSE # <br />USE OF BUILDING <br />GWl+�zPlLi� <br />WORK DESCRIPTION <br />37iiZ ZlS C�cl�jL <br />HEATSOURCE <br />_ Eleclric _ Gas _ Other <br />J 1�. <br />PHONE +-� 2S'' 2 S�( -% Z S�C1 <br />�{z)' Z� i-7Z lD <br />CONTRACT PRICE OF WORK <br />Loly S1L2��c-TIC,� Q% l3 2�I }c Z�v' `��p �-f2J4c4f< C r�{te.rlC.^�L <br />N0. � TYPE OF FIXTURE OR ITEM <br />Toilel <br />BaUiWb <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Waler healer <br />Sink (service'bar/mop/elc.) <br />Backllow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease Uap <br />Roof drains <br />Other <br />� <br />N���_ <br />NO. I TYPE OF FIXTURE OR ITEM <br />F;C. - air handling unils <br />Forced air syslems <br />Gas piping <br />Walen c�ater <br />_ Gas firepiace r� <br />_ Gas range �`L, y\� <br />Cloihes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined ihis application and know the same to be true and correct. All provisions of laws and <br />ordinaces governinc� this type of work will be complied wilh whelher specified herein or noL The granling o( a permit does not presume <br />to give aulhoriry lo violate or cancel ihe provision of any other slate or local law rec�ulatinc� consWction or lhe performance of <br />consiruction. That I am authori2ed by lhe owner of this property to pedurm Uie work for which applicalion is made and I compry with lhe <br />Slal` �Contraclors tv 18. 7 RCW and 296.200 WAC. <br />/_ `,_f i ��� z-/ Y�vB <br />�/a <br />