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PE�tMIT 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 />y-ab-o5 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />37oZ <br />LEGA LOT NO. <br />l�fi41�� (�i''�)(��I.VS�� \ <br />TENANiNAME <br />PARCEL TAX I.D. # <br />��Ct� f�— Z y- OS3o �c,� uzo 00 <br />BLOCK TRACT <br />ADDRE55 CITY2IP <br />(3�`< l20!(�( r'LUF4'�C�-`�T �U.6� �. <br />CONTACT FOR PERMIT <br />�t z � ' Z��i'-�a � <br />PHONE <br />CONTRACTOR �V���v-�J G�,Q� �NL ADURESS ��VZ ���� CITY2IP PHONE <br />y � (z�� ZS�('7Z�Zi <br />CONTR. LICENSE k���t LL' ��� SG� �,�7i )�D%n <br />`�� �� <br />USE OF BUILDING <br />GALZI'�,�z <br />HEATSOURCE <br />�r� / n � _ Eleclnc _ Gas _ Olher <br />CUNTRACT PRICE OF WORK <br />t ��c�cr� — <br />WORK DESCRIPTION G ��t.�������,J �� l' A� Z S K�(() l�-ct)1) (=-12�10�fF GG�U2(11�:.'c � <br />�ul�Cl�i- �L(�P� F-�-L:IJI�t�Tlc�J <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilel <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/bar/mop/elc.) <br />Backllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />� Olher ti�� _S}��'C4v�- ��i.if.� <br />�ul\'tY'� � �N[i. <br />NO. � TYPE OF FIXTl1RE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhauslfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TN( CODE IS 3105 <br />I hereby ceritiy that I have read and examined this application and know the same ro be true and correct. hll provisions of laws and <br />ordinaces governing tnis type of work will be complied with whether specified herein or noL The granting of a permit does not presume <br />to give authonry to violate or cancel the provision of any other state or local law regulating construction or the perfortnance of <br />construction. That I am aulhorized by the owner of this property to perform Ihe work for which application is made and 1 comply with the <br />81a e C��/cto� aw 9 2�7 RCW and 296.200 WAC. <br />, - ` '' <.J'c;._ a.r— 3 - / G: -0 5 <br />gnalure of Own r/ContractorlAuthonzed Agent Dale �/ <br />Z <br />