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P�ERMIT APPLICATlON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-2� T-8810 — FAX 425-257-8857 — www.everettwa.org <br />SITE ADDRESS <br />ss�s s, �� A� <br />LEGAL LOT NO. <br />1tiYh hSL(�SA��I K%1 T ZE <br />TENANT NI1ME <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. • <br />cx�-5c�—o�/ - oo�-oo <br />BLOCK TRACT <br />�/ T�N oF Lo6�@.l,L <br />�� 5� <br />CONTACI <br />A�E EvE�m <br />PERMIT � <br />GJ�.�/2�/ <br />PHONE <br />yir y3S- 13z8 <br />:�a� <br />PHONE <br />�3FF�- rsus,a.� tG�rz� ( sait �125 y�'6 �3zs' <br />CONTRACTOR ADDRESS CRY21P PHONE y)a 11�' � L63q <br />2.I� �yi2D irt. Oo��u u N� (arvSt�lluc T(oIJ I� •'3 eZG � y IQ vL %i L Sda nEl'.�L l�A. �1b 155 <br />CONTR. LICENSE N �L H AM D�I b� �� C7 �+%�\ <br />hui ��.nE� 11 i�t r tIr�IR.r4/ wu.��Nv�uC, l,�%i• //�/O.�c�LAI _ <br />USE OF BUILDING I HEAT SOURCE . NTRACT PRICE OF WORK <br />12Y 5 1 0 4N l ii X Elecincl� Gas _ Other <br />WORK DESCRIPTION <br />iNs�w�� z�,,�s F��ac a�n�cs ��,.+� i vns a.,�-� iaearcC <br />NO. I TYPE OF FIXTURE OR ITEM <br />Tdle� <br />Ba�htub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Laundry lray <br />Sink (service/barlmop/elc.) <br />Backflow prevenler <br />Urinal <br />Dnnking Founla;n <br />Floor drain <br />Grease irap <br />Roof drains <br />Olhur <br />NO. <br />TYVE OF FIXTURE OR REM <br />AIC - air handling uni�s <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gasrange <br />Clolhes dryer <br />Range hood <br />Exhausl fan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />CfTV OF EVERETT LOCAL SALES TAX CODE IS 1105 <br />I hereby cenlify thal I have read and examined this appliu�lion and know lha same lo be Inie and correct. Ail provisions of laws and <br />orclinaces goveming Ihis type of work will be complied vnth wheiher speci(ed herein or noL The granling of a permit does nol presume <br />lo give authonty lo violale or cancel Ihe provision of any olher slale or local law regula6ng consiruction or Me pertortnance of <br />consWction. That 1 am authaized by Ihe owner oi Ihis property to pertorm lhe work for which application is made and I com�ly wilh ihe <br />Slala Contractors Law 1827 RCW and 296.200 N'AC. <br />�1: 1 �u, <br />