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SITE <br />P`RMIT APPLICATI(��� <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 />7 ab-o5 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />LOT NO. I BLOCK I TRACT <br />PARCEL TAX I.D. # <br />�P�ERMIL# <br />fJ �� �' U��/' <br />5f�(�l-I�M�SN �l.�r.ITI, <br />TENANT NAME �(� � � CONTACT FOR PERMIT PHONE <br />/aa�n� � �� s�r�n�,`I i3<���-, _u� [�2,UW�J ��u�)"��g - �781 <br />CONTRACTOR ����'� N S'J ADURESS CITY/ZIP PHONE <br />3l �� CZ�CKErL.�L.C-2 � Z�l � JrC�( — ZCa�Z) <br />CONTR. LICENSE # �`...jp �,�T 1W�a , (` p'\Z/ � <br />_i d v <br />USE OF BUILDING <br />��ICC S� C � <br />WORK DESCRIPTION <br />�l.i (L �f �l,L� v�l r' <br />�( r/� Z�S , Se_'L� c � <br />.,, „�.� <br />HEAT SOURCE I CONTRACT PRICE OF WORK <br />Electric Gas Other <br />��c l$;l /�-� L� �-i I L�� I�-� �lL1 //LIL l,J ��'-\ /L i l i� �l,v <br />/\t� t,.J ���.1�.5 <br />NO. I NPE OF FIXTURF. OR ITEM <br />� Toilel <br />Dathtub <br />Lavatory (�vash basin) <br />Sho�ver <br />Kilchen sinA 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (scrvice/bar/mupietc.) <br />Backllow prevenlei <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />OUicr <br />NO. � TAE OF FIXTURE OR ITEM <br />NC — ai� handlinc� unils <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas ra ic�e <br />Clothes drye; <br />Ranc�e hood <br />Exhaust fan <br />Fleat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />1 hereby ceriti(y ihat I have read and examined this application and know the same lo be true and correct. All provisions of lews and <br />ordinaces goveming this type of work will be complied with �vhelher specified herein or noL The granting of a permil does not presume <br />to give authorily lo violate or cancel lhe provision of any other slate or Iocai law regulating consWction or the performance of <br />conslruclion. That I am aulhorizcd by Ihe owner o( Ihis properly lo pedorm lhe work for which application is made and I compiy with lhe <br />State r ctors Law 1G.27 RCW and 296.200 WAC. <br />lJ/���" ���iG��� <br />Signature uf pwnedContractor/Aulhorized Agenl Date ��� <br />