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F�Er2MIT APPLICATIOi� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERE'rT, WA 982G1 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />SITE ADDRE-SS <br />� ���� <br />LEGA LOT NO. <br />?G Y srd 5 � �v <br />TENANT NAME <br />� <br />CONTR. IICENSE # <br />USE OF BUILDING <br />� r- <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br />ie�-.�v <br />BLOCK TRACT <br />�,��� ���� <br />v l�� �e 13r-y� <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />PathWb <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washcr <br />Laundry lray <br />Sink (service/bar/mop/elc.) <br />6ack0ow prevenler <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Grease �rap <br />Roof drains <br />Other <br />PARCEL TAX I.D. # <br />v��� U�a- 9�� <br />COtJTACT FOR PERMIT <br />J� <br />F/ �AD��E����7 <br />��3— � <br />� CITY2IP <br />�nc; <br />� <br />HEATSOURCE <br />_ Eleclric _ Gas _ Other <br />PERMIT # <br />;� " l3 <br />PHONE <br />e�/ f�j�_ 'Z SC3� i 2� <br />r ��` <br />PHONE <br />� ��7y SL/ <br />PHONE <br />CONTRACT PftICE QF WORK <br />���'� ��` ' <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handlin� unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dp�er <br />Ranc�e hood <br />Exhaust fan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CCDE IS J105 <br />I hereby ceriti(y that I have read and examined lhis applicalion and know the same ro be trua and correct. All provisions of laws and <br />ordinaces governing lhia type of work will be complied �vith �vhether specified herein or not. The granting of a permit does not presume <br />lo c�ive authonly to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />conslruclion. Thal I am aulhorized by the owner o( lhis property to periorm the work (or �vhich application is made and I comply wilh the <br />Stalef.�ontractors L�y tE,27}�CW and 296.200 WAC. <br />i <br />1.��,�,.�.c�•�� '�� .� �� <br />