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P�:RMIT APPLICATIt�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, bVA 98201 <br />425-257-8810 — FPJC 425-257-8857 — wn✓w.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />%' '� �J/'_ <br />LEGA LOT NO. <br />DESC. <br />OWNER 7--jy� r�=" �,iLv Y4 <br />a i � A�� r��,� <br />TENANTNAME <br />CONTRACTOR <br />; <br />CONTR. LICENSE # Y�� ���� <br />USE OF BUILDING <br />PARCEL ?AX I.J. # <br />i'� � v � <br />BLOCK TRACT <br />�F �4„�f;�` ADDRESS . <br />yy:a �y'itC.'.�iy� <br />'n0" �i'�f .Oi,':i., ��r��. <br />CONTACTFORPERMIT <br />A�D 55 <br />� %�r�,�_1 -�7��x_� � [� �� <br />//; �i/r/-1L���� /. <br />A <br />CITY2IP PYiONE <br />9z7 �^ 3S i}„ � <br />HEATSOURCE 3/j�/ <br />_ Electric _ Gas _ Olher <br />WORK DESCRIPTION <br />�}���,� ,;.1 4-_�,s��r�y `.azPci�� __ �/ <br />NO. I -YPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink �4 disposal <br />Dishwasher <br />Cbthes washer <br />Laundry tray �� <br />Sink (service/bar/�p/e <br />Backflow preventer �, <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WC <br />/7 _��S - <br />�fJ2 �'�/ <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas firedlac� <br />Gas range� <br />Clolhes drye <br />Ranyehood <br />Exhausl fan <br />Heal pump <br />Unil healer <br />8oiler <br />CIiY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby cerilify that I have read and examined this application and know the szme to 6e true and correct. Ail provisions of faws and <br />ordinaces governing this type of work will be complied wilh whether specified herein or not. The gra�ting of a permit does not presume <br />to give 3uttoriry to violate or ��cel the promsion of any other stale or Iccal law regulating constructior� or the performance of <br />construcf n. That i am authon ed by thevwner of this property to perform the work for which application is m�de and I comply with the <br />State ntraetors Law.18.2�'f�CW ang�256.2C0 wAC. <br />. ' /; _ � _G�_ <br />S��n tUr^ �e�7f awfler/CoTtrac;ovA�thonzed A�ent ' Date �/Z <br />