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PERMIT APPLICATION <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 ACCEP7ED <br />SITE ADDRESS PARCEL T/U( I.D. p ' <br />�$RMI�I,_ . � <br />N12'o R�..ckER AoE 005$2'101�10'1100 � �.��—/ <br />LEGAL LOT NO BLOCK TRAf,T <br />DESC. 1"1— 2 S p� u <br />SM�F�Wqy INL, <br />TENANTNAME <br />SRF�WW�� ��.tG <br />CONTRACTOR <br />EL.�TE �o..MeR��n� <br />� NTQq caT I M <br />CONTR. LICENSE p � <br />E��recc. pry��� <br />USE OF BUILDING <br />CONTACT FOR PERMIT <br />JJ ST � <br />ADDRESS <br />�y hl. MgEkge ST, <br />S••.Tc tr �.,. <br />HEATSOURCE <br />-•••.�•� rnvnt 9yr�s <br />' 200 �.I Ac �f �r ��66K G <br />PHONE <br />— Zss-44�-3iz.� <br />CITY21p pHONE <br />Ke•�-r �z s 3� <br />94osz x53-3ioo <br />I CONTRACT PRICE OF WORK <br />�o.ar+E2c..a� �¢„�n.ti � _Electric Gas Other <br />WORK DESCRIFTION <br />/��"���N"Yle.a OP A 5'TaFD4c�t[ Sipp� {3q2 <br />� sa�w.,y. <br />NO. I ryPE OF FIXTURE OR ITEM <br />1— <br />i one� <br />Ba�htub <br />Lavatory (wash basin) <br />Shower <br />�(itchen sink 8 disposal <br />_� Clathes washer <br />� Laundry Iray <br />� Sink (servicelbarlmop/etc.) <br />_� Backllowpreventer <br />� Urinal <br />� Dnnking Fountain <br />a Floordrain <br />� Grease lrap � <br />� Roof drains <br />Other <br />3S, o00 <br />NO. I TYpE OF FIXTURE OR ITEM <br />_ .��—airnanaungunils <br />_ Forced air systems <br />Gas piping <br />Waler healer <br />Gas fireplace <br />Gas range <br />_ Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />_ Woodstove <br />CITY OF EVERETT LOCAL SALES 7N( CODE IS 3f 05 <br />I hereby cer,tify that I have read and examined this applicalion and know lhe same to be irue and correcL All provisions of laws and <br />�rdinaces goveming this lype of work will be complied with whether specified herein or not. The granting of a permit does not presumo <br />o give authority lo violate or cancel the provision of any other state or local law requlatin� construction or lhe perfortnance of <br />:onslruction. T,�h,a�ty,��,, authorized by the owner of this property to perform ihe work for which application is made and I comply with the <br />>tate Contrai%l'l�^ 18.27 RCW and 296200 WAC. <br />w <br />8', s, os- <br />