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SITE ADDRESS <br />�i l/ I / � <br />LEGAL LI OT NO. <br />t,�, �l p <br />TENANT NAME <br />e�, <br />PERMIT APPLIC�ITI(�N <br />CITY OF EVERETT PERNi�T SERVICES <br />32•�0 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PNi a— a-`'f �Q� <br />� PARCEL TAX I.D. # P�RMI7 # <br />/�'` "�- i:�'� �� •\�L��-� _ � <br />BLOCK TRACT OR SUDDIVISION p <br />ADDRE55 CITY/ZIP PHONE <br />ae3i ✓{'�crr ,�, qY�i `!Z5- <br />'V,.�yia�� av"• L — -w — <br />CONTACTFORPERMIT �-tlt1�5 P PHONE2((�-7ti�/-(s((�' <br />y�{ ��h"Scs��Plv��di.�l• E-MAIL'. ,. yy7-�as� <br />�e.t� �"p�i.>�o..�1���vifj�vt(J IOQII -yrQ�.i�+1:tJ,4vt-c' Sc'qTl't.t�,i4, 2G�'��Y�/'�f5 /� <br />CONTR.IICENSE# / � 9Cs�33 <br />� , �_� <br />USE OF 6UILDING <br />s���y�z �'y�h� I� <br />WORK DESCRIPTION <br />i <br />� � <br />��;�. � ��< �� <br />tv0. I TYPE OF FIxTURE OR ITEM <br />Toilut <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />_ Kilchen sink R dispos�,l <br />Dishwasher <br />Cluthes washer <br />Waler heater <br />Sink (servicelbar/mop/elc.) <br />Backflow preveNer <br />Urinal <br />Drinkinc� Fountain <br />Flour drain <br />Grease lrap <br />Roof drains <br />_ olher R fq�i {�Lils;' w��,�:, <br />VPT�, fn:�P. <br />HEATSOURCE <br />_ Electric _ Gas jQ_ Othur <br />�• — <br />/ <br />GC.� � ` CT �_ <br />� NO. I <br />CONTRACT PRICE OF WORK <br />7YPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air syslems <br />Gas pipiny <br />Waler healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Ranye h;,od <br />Exhausllan <br />Heat pump <br />Unil heale� <br />Boiler <br />Refrigeration <br />Woodslove <br />CITY OF FVERETT LOCAL SALES TAX COD[ IS 3105 <br />I hereby ceriG(y thal I have read and examined lhis application and know lhe same lo be true and correcL All provisions o( laws and <br />ordinaces yoveming this lype of work will be compliad wilh whether s��ecified herein or noL The granting of a permil does not presume <br />to give authorily lo violale or cancul ihe provision of any olher slate or bcal law regulatinc� construclion or the per(ormance ot <br />construction. That I am aulhorized by the owner u( ihis property lo pertorm Ihe work for which �pplication is made and I comply with the <br />Slale Coplractors Law 1p.27 RCyV and 2962�AC. <br />� <br />Z�y-i"G <br />