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� P�r2MIT APPLICATIG�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 � <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org C 05� ��p�� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NO CEPTED <br />SITE ADDRESS <br />LEG�I � T NO. <br />� I l R�l� <br />TENANT <br />� � Y�1 u-c.o <br />CONTRACTOR � 4 �L �,V� i <br />PARCEL TAX I.D. # <br />ND 9s�a <br />BLOCK I TRACT <br />PERMIT # <br />7C�6 " �is -i�� <br />CONTACT FOR PER IT <br />�pI�D2pG ��{.'CN�C.L�Z� �d,� <br />.�ny� DRESS CITYIZIP <br />�a�/ l�fJS� Crl,o�r�itl.i, <br />CONTR. LICENSE # <br />� L L 1� IC Ll) 09 `r' P�f' <br />USE OF BUIL�ING <br />�5 c ra�a.`?"'i.r� <br />WORK DESCRIPTION <br />K.�t <br />��� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Tailet <br />Bathtub <br />Lavatory (wash basin) <br />Shawer <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry trey <br />Sink (service/bar/mopletc.) <br />Backflow preventer <br />Urinal <br />Drinking Fcuntain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />a P-a �1'k- � (s�- <br />9y� <br />PMONE <br />-39�-ss�� <br />PHONE <br />aal -�36v,- <br />3� <br />— HEAT SOURCE I CONTRACT PRICE OF WORK <br />'� Electric Gas Other 4 S /� <br />D�y�•a�� ��z�'��/� <br />�,L�l/f i(/!�/ I b L� �-j • v. <br />.�—l6�ic, �v'�-i� G S <br />NO. I TYPE OF FIXTURE OR �TEM <br />AIC - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />Olher <br />CI7Y OF EVERETT LOCAL SALES 7AX COOE IS 3105 <br />I hereby ceritify lhat I have read and examined this application and know the same to be true and cortect. All provisions of Iaws and <br />ordinaces governing this rype of work will be complied with whether specified herein or not. The granting of a parmil does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the perfortnance of <br />constrvctiopj'That I am authoriz��e�by�t� e pyvner of this property to perform the work for which appllcation is made and I comply with the <br />State Co�Q/Fctors Law 18.27 R �(n ��� zoo wAc. <br />