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PcRMIT APPLICATIC►i� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />L/�/� 4�5-257-8810 - FAX 425-257-8857 -www.everettwa.org <br />( <br />.� �� � j 1� � n APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS"' <br />�i�,-4,, s� . <br />LEGAL LOT NO. <br />l/ - �-�'! <br />(�.vs� o�- `� `-I <br />•=, ���� c..,c1 <br />PARCEL TAX I.D. # PERMIT # <br />� �. �<;o ���li�c����;z�cc C_.U9�X � <br />BLOCK TRACT OR SUBDIVISION # <br />�t <br />VYYfYCK �ivvnwo �.uvur rnvnc� <br />\lh �l J /% C1 <br />JvlloCi�� J��C.. 1�>US 7�u���-irJlllC IIVC� ���..'C IJ� �no`l• �''18�Y�110 C��vCj- 1�_`l`� <br />TENANTNAME I CONTACTFORPERMIT PHONE�{25-3�%�'1-(��� �p� <br />I��l �{ C' <br />GONTRAGTO r1 �n 11 <br />�,.l�ll�:li �a•�lV��\��'i����\��V.\ <br />CONTR. LICENSE il <br />CiY\C C��'� � l CI ��_��� V'�� lC <br />USt OF BUILOING <br />\ i_':, � (1.�_' �-� t cL \ <br />MV V RCJ�I <br />���.�1�1�_ ��crUlc'•�'�i�l �lyl <br />��JJ-\`t' � <br />�(lU�1CY1-��`.��.�.lil�� �l�o <br />HEATSOURCE <br />✓Eleclric _ Gas _ Other <br />WORK DESCRIPTION ( � I <br />I���`'.._� CC��°,\✓���,,�c��-1 ', CLCiCII',�1���.' L����J��,X <br />NO. � TYPE Of FIXTURE OR ITEh1 <br />Toilcl I � 1 j � y�, <br />Oalhlub \I 1 <br />Lavalory (�v�sh basin) � 1 l�\ 1 <br />Sliowcr <br />Kilchen sink 8 disposal i 1 <br />Dish�vasher � � <br />Clolhes washcr I I <br />W aler healer <br />Sink (service/badmop/etc.) <br />Back(low prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease Irap <br />Raot drains <br />Olhcr <br />E•MAIL�I�UY%CxJ Ilb('_.C(,� <br />��� L �� � l <br />��� � Z `� <br />CONTRACT PRICE OF WORK <br />�" �,'.�g�i�UG.UU <br />(��„2-�� - �-i-J <br />�..,.pwx - 2�� F Z' <br />NO. I TYPE OF FIXTURE OR ITE�7 <br />NC - air handlinc� units <br />07 Forced air systems � � <br />'2. Gas pipinc� <br />1- Waterhea�erl l <br />�__ Gas fireplaco <br />Gas range <br />7= Clolhes dryer 11 <br />"1_. Range hood 1 1 <br />C, Exhaust (an 11 1 1 � I <br />Heal pwnp <br />Unil healer <br />Boiler <br />Refric�cration <br />Waodslove <br />CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify lhat 1 have read and exainined lhis application and know Oie same to be lrue and correct. r'�II provisions ot laws and <br />i ordinaces goveming lhis lype of �vork will be complied wilh whelher specitied herein or noL The granliny of a permil does no� presume <br />, to give aulhority to violate or cancel ihe provision ot any olher stale or local law re9ulaling conslruclion cr tho periormance of <br />. conslruclion. Thal I am authorized by tho owner o( lhis property to perlomi the work for which application is made and I comply with Ihe <br />I Slalc Coniraclurs La�v 18.1.7 RCW and 2'J6.200 WAC. <br />�--.>-�� Z" tc n�� mc�n�:�:'.\ � 4 G`I <br />� OwnedConlractor//5 Ihorized Agent '� Date �I <br />� <br />