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l <br />PtRMIT APPLICATIdN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEr�ETT, 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 <br />M�L`Ou6�u.- �+'�3- <br />LOTNO. BLOCK <br />TENANTNAME <br />�/� <br />TRACT <br />PARCEL TAX I.D. # <br />0 <br />7 �7 S• L�De►2 5'1'. <br />CONTACT FOR PERMIT <br />CONTRACTOR ��'�"��� $���t�,z+ ADiR�SSI�3� L� <br />RVC/ <br />/ 7� <br />CONTR. LICENSE # <br />l�rt- I n R. nq �n r-� <br />USE OF BUILDING <br />�h���i�' <br />WORK DESCRIPTION <br />PERMIT #/ <br />��o %> l� ' l� <br />� S� p � � �-iati.� <br />CITYIZIP PHONE �L, 62 • S O <br />Sema� w� ,�-g 134 <br />PHONE <br />� �cyir�vrziP <br />I/�G <br />5��.1s <br />HEAT SOURCE <br />_ Electric _ Gas _ Olher <br />�mousi4 � �.QvE '�l5rt N b <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwashe� <br />Clolhes washer <br />Water heater <br />Sink (service/bar/moplelc.) <br />8ackllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Uap <br />Rool drains <br />Olher <br />� <br />4ZS 33� ,� <br />�� <br />� SZSP� <br />CONTRACT PRICE OF WORK <br />� 750� � <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas (ireplace <br />Gas range <br />Cblhes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit healer <br />Boiler <br />Re(rigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cer al I have read and examined this 2pplication and know the same to be We and cortecL All provisions of laws and <br />ordinaces g �c� this type of work will be complied with whether specitied herein or not. The granting of a permit does not presume <br />to give authomy tu violate or cancel Iho provision of any other state or Iocal law regulaling consWction or lhe performance of <br />construclio at I am aut nzed by lhe owner of this properly to perform lhe work for which applicalion Is made and I comply with the <br />Sfat�Gont ct s Law 18.2�RCW apd 2�200 WAC. <br />N� � N�t�e� <br />Z�� �E4 � <br />