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PEr�MIT APPLICATIO�� <br />CITY C�F EVERETT PERMIT SERVICES <br />320C CEDAR STREET, EVERETT, WA 98201 <br />425-257-F 810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />� <br />�D/f� Jvu <br />LEGA LOT NO. <br />CESC. �' <br />�� ��� <br />TENANTNAME <br />L <br />PARCEL TAX I.D. # <br />:> �v ���iUU,�a oz� <br />8^ CK TRAC^` � � <br />W! �-L�A1Y15 . J��/c� JO <br />CONTRACTOR /� <br />CONTR. UCENSE # / /��/ _ ( p /1 <br />l/ �v �i/� <br />USE OF BUILDING <br />�"1'�`S IDh.JC� <br />WORK DESCRIPTION <br />���s . <br />E-c.c— <br />uZ�A✓ - �v. <br />ICONTACT FOR PERMIT <br />AD�RESS CITY2IP <br />— HEATSOURCE I <br />Electric Gas Othe• <br />I l/'YUY —% <br />PHONE /��S 1 <br />C, � <br />�_%�`Zo� 2S5'•/y <br />PHONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />,Sovv.v� <br />�/Y1.':� tr�� �X J S�7 n/ e, ��.D '�o tii�� �.S�T E�.Ju�.o7 � 7%E.D <br />� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavarory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />� Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Unnal <br />Drinking Fountain <br />Floor drein <br />Greasetrap <br />Roof drains <br />Gther <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />^ Forced air systems <br />Gas piping <br />W ater heater <br />� Gas fireplace <br />Gas rarge <br />Ctothes dryer <br />Range hooG <br />Exhaustfan <br />Heat pump <br />Unit heater <br />6oiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETf LOCAL SALES TAX CODE IS 71r,5 <br />I he�eby ceritify that I have read and examined this applicatlon and know the same ro be t:ue a�d correct. All provisions of 12ws and <br />ordiraces ga er -ng this type of work will be complied wdh whether specified herein or naL The granting oi a permit does not presume <br />to 3ive au o o vi late or cancel the provision of any other state or local law regulating construction or the performance of <br />cons;ruc o. T t I m authorized by t owner of this property to perform the work for �vhich auplication is made and I comply with the <br />State C a s w 18.�� R�N 96,L'00 WAC. <br />� %�/. Q�u 7��P <br />Siqnsture o wneriContrector;Authon ed Agent Date ��L <br />