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P�RMIT APPLICATIvN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 – FAX 425-257-8857 – �vww.everettwa.org <br />�•.a0-O(� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREOIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />331Q <br />LEGAL LOT NO. <br />DESC. � Q <br />�n c.Kdc�Y�.L�.�C <br />BLOCK <br />`1 a 3 <br />�i-1'`/� l9i�RT��eR� <br />TENANT NAME <br />�a �� <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />Na r,./� <br />WOFK DESCRIPTION <br />�c CUtc� l� �rttqu <br />t e2 S's <br />PARGEL TAX I.D. # <br />Ob�{39 0'1�3 CJ 10 O b <br />TRacr <br />�U��n.c�� ( _au,n Co S i s'�kl�. <br />P��:�B=�x i25s3 <br />u.� r���� co��rc <br />I COtJTACT FOR PERMI <br />� (� <br />�d <br />U N�T <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 3 disposal <br />Dishwasher <br />Ctothes washer <br />Laundry tray <br />Sink (servicelbadmop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Foun:ain <br />Fioor drain <br />Grease :iap <br />Roof drains <br />Other <br />..•. <br />M � (C�. To p � <br />AD�RESS <br />HEAT S URCE <br />_ Electric V�' �_ Other <br />Kk� sr� ��cS���,,�.ck <br />� C� <br />CITY2IP <br />�u <br />PERMIT # <br />Ao�o�- o <br />13�k 7Q 3 <br />yz�-�sy•b7 s o <br />PHONE <br />y2s-�S�f- � 3b b <br />PHONE <br />CONTRACT RICE OF WORK <br />N /� <br />r�a �. u,� `i <br />NO. I TYPE OF FIXTURE OR ITEM <br />M'C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust tan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Oiher <br />—I <br />GTY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I herehy ceritif}� that I have re�d and examined this application and kno�v the same to be true 2nd correct. All provisions of laws and i <br />ordinaces goverNng this type of �vork will be complied with whether specified herein or not. Th^ �ranting of a permit does not presume �, <br />to give authority to vioiate or cancel the provision of am• other state or local law regulating construction or the performance of ! <br />construction. That I am aut by the owner of this property to perform the work for �vhich application is made and I comply �vith the I <br />Slate Contractors Law 1.27 RC' rU] 29Fj,2G0 NJAC. � <br />i-�§3-b l� � <br />Date I <br />— � <br />