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� <br />P�r�MIT APPLICATIO�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 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 PM - DEBIT & CRE�IT CARDS ARE �OT ACCEPTED <br />SITE ADDRESS <br />oZSZZ V��ci�r/� <br />LEGA LOTNO. BLOCK <br />r4 � ti. <br />TENANTNAME <br />��� <br />CONTRACTOR �i j /�/E;f (ot� <br />PARCEL TAX I.D. il <br />x TRACT <br />AOOR[SS <br />.25�'z G%�,-�;i.icl�: /�ve <br />I CONTACTf <br />ADORESS <br />2 PERMIT <br />�! 1� <br />�/-77�� �.SkJ, <br />PERMIT# <br />' U2 23 <br />i sr -- <br />PHONE �/ <br />- - <br />9 ���i -zss•_�3�.� <br />P WE � <br />�/Z5 �,j 0' � �! � <br />�ref�'HONe y�S =3SS- /78a <br />CO�TR. LICENSE # G�i TJ'� cc 9?3v3 �� -� <br />98=�3 <br />J���Z�S <br />USE OF BL'II.DING I — HEAT SOURCE I �CONTRACT PRICE OF WORK <br />.� <br />Electric Gas Other i /%Z� �!UU, <br />WORK DESCRIPTION �LW O<<Y�i�//� lv% Zl 2(,(GL`� C�1,( �D� �'6v�s(� �u;,,� SJT�j�- <br />YLUMtlIN(i <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ Bathtub <br />Lavatory (wash basin) <br />Shawer <br />Kitchen sink 8 disposal <br />i_ Dishwasher <br />. Gothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Flour drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />_ Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />_ Gas range <br />Clothes dryer <br />Range ho�d <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(ngerelion <br />Woodstove <br />Other <br />CITY OF EV,SREri' LOCAL SALES TAX CODE IS J105 <br />� I here6y ceritify that i have read and examined this application and know the same to be true 2nd correct. All provisions of laws and <br />ord�naces goveming this type of work wdl be complied with whether specified herein or not. The granting ot a permit ooes not presume . <br />to give authonry to violate or cancel the provision of an,� other siate or local law regulating construction or the perforrr,ance of ' <br />construction. That I am authorized by the owner o( this property to perform the work for which application is made and I comply with the '� <br />State Contrae;brs Law;4$27 RC'JJantf ?.96.200 �VAC. �i <br />�"�o "' G� S I <br />Date I/� II <br />