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� <br />;: <br />PL�MIT APPLICATIG�J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 � /,G, I� <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org 5U0 <br />APPLICPTIONS ARE ACrEPTED FROM R AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />����I <br />LEGA LOT NO. <br />TII <br />L q �< t c,�,J� <br />TENANT NAME <br />CONTRACTOR (,A I�E �.,4rJ✓� <br />PARCEL TAX I.D. # PERMIT # <br />>d- z���y�3-c,oz-o��-o0 5/��-9 <br />BLOCK TRACT „'P d1 y(�-Ioyb75S' Sccnad i3 zp,,..rwir Z.tN <br />,'�..m�� �n��t �70Lo91w7{ Q.USc V u�rr. <br />ADDRESS CITY2IP PHONE <br />��un9l:S 1��c. Pu�,�'uX �Y� LK� S7�v�✓S S�zSJ% `/2S-3S(,��74� <br />I CONTACT FOR PERMIT PHONE <br />„tv` wAr_�3�5 `/z� 31`G 7�� 7 <br />IiotlicS �i7c '4DDRESS CITY21� PHUNE <br />CONTR. LICENSE # L/� kt L H S OC� � TL <br />USE OF BUILDING <br />SF�� <br />WORK DESCRIPTION <br />, <br />��S�i�uC7�c�f Oi� <br />HEAT 50URCE I CONTRACT PRICE OF WORK <br />Electric � Gas Other <br />��&c: �� Sr"r hAs� c l� �3 ) <br />NO. i TYPE OF FIXTIIRE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothae washer <br />Laundry tray <br />Sink (service/bar/mop/elc.) <br />Backflow provenler <br />U!inal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher _ <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water heatcr <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />N'oodsrove <br />Olher <br />CITY OF EVERETf LOCAL SALES'fAX CODE IS J105 <br />I hereby ceritiy that I have read and examined lhis application and know Ihe same to be true and correct. AII provisions of laws anJ <br />ordinaces governing this type o( work will bo complied wilh whether specified herein or not. The granting of a permit ooes nol presume <br />to give aulhonly to violate or cancel lhe provision o( any olher state or local law regulating consWction or the performance of <br />consWciion. That I am authorized by lhe owner of this pmperty to perform the work for which application is made and I wmply with t'ne <br />Stale Contraclors Law 18.27 RCW anA 296.200 WAC. <br />�.---...-- -.,.__ ��.. . ��' . �/S �os '/a <br />,.-, 2 , � <br />c oSO�-v�y <br />