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� <br />�� <br />;� <br />SITE ADDRESS <br />%�%�J .Sl�c I <br />LEGAL LOT NO. <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.evereriwa.org <br />� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK ' I TRACT <br />PARCEL TAX I.D. # <br />/� a� �-�� <br />PERMIT A <br />'✓1 l�lU-o5� <br />urvn�rt qwKtSJ��'\r �� GITY/ZIP PHONE �G�C� <br />,�.\ \ / � � <br />J�'�y �-�-i-<�t' �vnrm��u ��r�[r ��i �i3`3� Vai� jC-�n svi..� '�stv� i�.� �� <br />TENANTNAME CONTACTFORPERMIT PHONE <br />ArH Q i�a�� ���n -�?�q � -7�9 �, <br />CONTRACTOR ADDRE55 CITY2IP PHONE <br />C�' S �k;����+��a, C�):� .�� E� s1-(11R �,., /�1en� � <br />CONTR. LICENSE p � <br />�s-3+E�• c �z 93 �1 � 1�� `1�z �� 3C--° 7qt� �'?3�� �, <br />USE OF BUILDING <br />HEATSOURCE <br />_ Electric �, Gas _ Olher <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />� �� �� �� <br />ic�s[:4 j� ►'�2 �3 r�o c,�/ c�.� , � y'-`/� � <br />j � ��� ,�' -�a� ►u�;i- <br />V�� r� ij-►�-� fa a- <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry lray <br />Sink (service/bar/mop/etc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trep <br />Roof drains <br />Other <br />� <br />`5����r,� <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeretion <br />Woodstove <br />Other — <br />CITY OP EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this application and know IhA S2rt12 l0 bA tNA 8�d CO�fACi. /1�� (1(4VISIOIIS Of �2WS 2(I� <br />ordinaces governing this type o( work will be complied with whelher specifed h=rein or no4 The granting o( a permit does not presume <br />to give au[hority to violate or cancel lhe provision ot any other state or local law regulating construction or the performance of <br />construction. That I am auihorized by the owner of this property to perform the work for which application is made and I comply with the <br />State �ontradors Law 18.27 RCW and 290.20� WAC. <br />� %at`� N, <br />laf�/ <br />