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P�RMIT APPLICATI(��V <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 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />i �(� 5-�- V; e w 1� �- C� <br />: <br />LEGA LOTNO. BLOCK TRACT <br />DESC. � <br />3 O� O-p o 0 <br />. <br />w� � 1 � c,_.�, <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE p �LL� 1�� �� <br />USE OF BUILDING <br />�� � �.� < < _ �L v�„ ; < < <br />WOR DESCRIPTION <br />!� �I �.� , a , �..-. <br />NO. I TYPE OF FIXTURE OR ITEM <br />l Toile� <br />i Dalhlub <br />� Lavalory (wash basin) <br />� Shower <br />� Kilchen sink 8 disposal <br />� Dishwasher <br />Clothes washer <br />Laundry lray <br />Sink (service/barhnop(etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />PARCEL TAX I.D. # /P�ERMIT # <br />� lu O� 5C �� C�c�O Z Z oJ C'_ �Z <br />���,�-��_ �,x�•3 <br />2 3� v , W � � <br />CONTACTFORPERMIT <br />� � � � \ GJ�,.,. C <br />A�ORESS <br />HEATSOURCE <br />✓ Eleclric _ Gas /Olher <br />� r- c' �/ � !�' <br />5 � - -' <br />NO. <br />PHONE <br />�7 e'.. \�Z 1/ Z. <br />CITY2IP PHONE <br />�t251 <br />ZS 2 -1�1'q <br />� 2'z'4Z9 <br />CONTRACT PRICE OF WORK <br />`� l� FI � r <br />TYPE OF FIXNRE OR ITEM <br />A/C - air handling uni�s <br />Forced air syslems <br />Gas piping <br />Waler healer <br />Gas (ireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust (an <br />Heal pump <br />Unil healer <br />Boiler <br />Re(rigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby ceritify thal I have read and- Yamined this application and know the same to be true and correcL All provisions o( laws and <br />ordinaces governinc� this typ,00i work�j ill be complied with whelher specified herein ur noL The granling of a permit does nol presume <br />to give authonl�to violatp6r cancel Ih'e pro��ision of any other slate or local law regulating consiruction or Ihe performance of <br />consWction .i n�t I am authorized by the owner of this property to pedorm lhe work for which application is made and I comply with Ihe <br />Slat¢'ConlS�clors La i�8.27 R�yV and 296.200 WAC. � <br />_;`11, <br />0 <br />� <br />u <br />