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I�cRMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />LEGAL� LOT NO. BIOCK <br />DESC �T <br />OWNER <br />/1�er� ��Wi's 2� <br />TENANT N <br />��icJ� S <br />Li�/e`SCroas'� �•��- <br />CONTR. LICENSE NL/�� CG <br />USE UF BUILDING <br />��le� /CGc<<r�l� <br />�tc�ace� <br />PARCEL TAl( I.D. N <br />�P�' Oo 3 7 i</vo <br />TRACT OR SUBDIVI510N N <br />ADDRESS <br />�f/,� /oy�,�'� � <br />CONTACTFORPERMIT <br />�uKc� !�, � <br />a y ?�f�' Al,S'.kJ- <br />HEATSOURCE <br />_ Eleclric p Gas _ Other <br />WORKDESCRIPT�ON � Qcu� Zr�G( fl�,•� <br />� �C <br />,��r�� ��ty � <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilel <br />6alhtub <br />Lavalory (wash basin) <br />Showcr <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clo�hes washer <br />Water hr.aler <br />Sink (service/bar/moplelc.) <br />�ack(low preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Rool drains <br />Other <br />�.2r.vc �/�ar. <br />f:[.� <br />%vl' <br />P�ONE , <br />e�a� <br />c �-� <br />� 2o�la <br />�/25-33a-o�! <br />'-3ss-i �8� <br />C�ONTRACT PRICE OF WORK <br />��o ,ydo °� <br />�uC% s,�rr.,�E <br />9%�D� <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas (ireplace <br />G:�s range <br />Clolhes dryer <br />Rango hood <br />Ezhaustfan <br />Fleal pump <br />Unit heater <br />13oiior <br />Re(rigeralion <br />Woodslove <br />Other <br />LITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby ceritify thal I have read and ezamined Ihis application and know the saroe to be true and correcL All provisions ot laws and <br />ordinaces governing this type of work will be complied wilh whether specified hnrein or not. The granting of a permit does nol presume <br />to c�ive authority to violate or cancel the provision of any olher stale or local law re�ulating construclion or the performance oi <br />construction. hal I am author}'� d by lhe owner ol lhis property lo peAorm the �vork for which application is made and I comply with the <br />Slale Col'�ors L�aw 18.27/i3CW and 296200 WAC. <br />/ i//'- f' / 1 t /,^ �-- lJ � <br /><< � L, �1 <br />r--�Y—�� <br />'�v <br />