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SITE ADDRESS <br />:�t I ��4� 1'1� <br />LEGA LOT NO. <br />DESC. <br />;.Jn �1 <br />TENANTNAME <br />� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425•257-8810 - FAX 425-257-8857 - www.everetiwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />PARCEL TAX I.D. # <br />TRACT OR SUBOIVISION tt <br />� � �1. I�� K <br />CONTACT FOR PERMIT <br />CONTRACTOfl � 1 `.l�c.-� I- �,�C�.�� Y\S "��� <br />CONTR. LICENSE # , <br />�l �fn�l-/ 1 L�l�/� 1 �� <br />USE OF BUILDING <br />��� <br />WORK DESCRIPTION <br />� �^� �-} ��_ ( ( � Y?C' <br />L�I� S� � �1� I 7-=� <br />���.��� <br />z r 4�� S� , <br />�u ��cL� <br />HEATSOURCE <br />_ Electric � Gas _ Other <br />PERMIT # <br />'� U7iU-u`��a <br />PHONE <br />_rc„t �t,f �J� 2 c, � <br />PHONE <br />E-MAIL , ll ` C <br />. .. 1 "1d����'..J ] 3 <br />�))GCt.�<< (,( .rt 1b C: 3 � <br />CONTRACT PRICE OF WORK <br />O C� <br />`7�, (OCU, <br />C��Cts �" rt Gz-CP ,�C? ��� Cc� r� ci- �'�.ti� /-� <br />'t� `�.^--� rv�-+..�_ L,�':� ,�' <br />N0. I TYPE OF FI%TURE OR ITEM <br />� <br />Toilet <br />E3alhtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dish�vasher <br />Clolhes washer <br />lVaicn c�ater <br />Sink (scrvicc/bar/mop/etc.) <br />6ackllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasc trap <br />Root drains <br />Other _ <br />CU71 <br />TYPE OP FIXTURE OR ITEM <br />NC — air handling units <br />Forced air systems <br />Gas piping <br />Watcr heater <br />Gas fimplace <br />Gasrange <br />Clothes drycr <br />Range hood <br />Exhausllan <br />Hcat pump <br />Unit heater <br />Boilcr <br />Refrigeration <br />Woadstovc <br />i <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />�I I hereby cerilily Ihat 1 have read and ezamined Ihis application and know the same to be true and correct. All provisions of laws and <br />I oidinaces goveming this type ol work will be complied with whether specilied herein or noL The granting ot a permit does not presume <br />� to give authorily to violate or cancel the provision ol any other state or local law regulating construotion or Ihe pedormance ot <br />, construclion. That I am authorized by ihe owner of lhis property to pedonn ihe work tor which applicalion is made and I comply with lhe <br />'I State Coniractors Law 1827 RCW and 2 6.200 WAC. <br />% <br />(� <br />� i �(���i�� I `���.� � ( �.i �'r( /L'� ��L,-� <br />Signature of OwneriConiractot/Authorized Agent Da e <br />