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P��tMIT APPLICATIC�i� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERET'f, 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 />LEGA O 07 N0. <br />BLOCK I TRACT <br />PARCEL TAX I.D. A <br />nFi�,�' S�HF«T .%���I ,('vckl2 Av/'. c <br />TENANT NAME I CONTACT FOR PERMIT <br />CONTRACTOR <br />S,r,� i j1/ ro ti_r��1uc'770 n/ <br />CONTR. LICENSE N <br />C - � S� S .�i <br />USE OF BUILDING <br />WORK DESCRIPTION <br />l�F'�L.r%� ('�� <br />ADDRESS CITYfZIP <br />ic�7?7-2i � 0/��F, <br />��F�zh-`r, �.il. 1 X }nd� <br />— HEATSOURCE I <br />Electric Gas Other <br />(�L(�� j/r�� //� �/ 1,.�%i i<� �ti� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />YNOf/E Lf 2 j _ <br />zoJ 2Aa�'fSs <br />PHONE <br />PHONE <br />JZJ "_ <br />l <br />�3����� <br />CpNTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTIJRE OR ITEM <br />AIC — aIr handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehoad <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Rehigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7NC CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. Ail provisions of laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or not. The granting of a pertnit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construcUon or the perfortnance of <br />construction. That I am authorized by the owner of this propert� to perfortn the work for which appiication is made and I compiy with the <br />Slat/e Co/n2� tors L�aw.18.27 RCW and 298/ 200 WAC. <br />C�I. ��, 7' / .\ �/,/: �/ 2G SE'a°D� <br />