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P�RMIT APPLICATI(��V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDHR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />� �30 -05 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCE'TED <br />SITE ADDRE S <br />� � " '�� <br />L[GA LOT NO. BLOCK <br />oesc. 16 �� � <br />OWNER <br />C�j,�12�FS 4111�_ <br />TENANTNAME <br />S �-VI'� <br />CONTRACTOR <br />CONTR. LICENSE p <br />USE OF BUILDING <br />� u� 2r>s� �c <br />C� (.PI,U C�O� <br />PARCEL TAX I.D. # <br />Ck�S' ' ' U c <br />TRACT <br />AUDRESS <br />> <br />,- <br />CONTACT FOR PERMIT <br />��_ <br />ADDRESS <br />HEATSOURCE <br />_ Eleclric �Gas _ Olher <br />WORK DESCRIPTION ' <br />'����- <br />PLUMBING <br />NO. I TYPE OF FI%TURE OR ITEM <br />r����� H f� icl�t c' <br />� j,��"t�`�,� <br />� Lavatory (wash basin) <br />� Z� Shower <br />Kitchen sink & disposal <br />Dishwasher <br />� �_ Clolhes washcr <br />Laundry tray <br />Sink (sen�ice�bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drein <br />Greasetrap <br />Roo( drain,s ' <br />= Other—'L�-��-���.LC-ti'� ( O)?4L' <br />� oc.� I 'c=5o� -�.� <br />CITY/ZIP PHONE 4 a� <br />= �; ����� �8�c,i a�� <br />PHONE <br />4a�q�o�$�� <br />CITYIZIP PHONE <br />CONTRACT PRICE OF WORK <br />��i CY({�r <br />�%Ct/1 2/ X��Z <br />��J:2! 2�Xi� <br />NO. I NPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />E,:hausl fan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeretion <br />Woodstove <br />CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify Ihat I h2ve read and examined this applicatior and know the same to be true and correcL All provisions of Iaws and <br />ordinaces governing ihis type of work will be complied wilh whether specified herein or not The granting of a permit does not presume <br />lo �i�e authority to violate or cancel lhe provision of any olher stata or local law regulaling conslruclion or the peRormance o( <br />construction. That I am authorized by Ihe owner of this properly to perform lhe wurk for which application is made and I comply wilh lhe <br />Sla nlrectors aw .�7 RCW and 296.200 WAC. <br />. nC / <br />� �Ct - _��� 1 � ^ � � "" �/ J <br />SignaWreo(Owned o- or/Auilionze gent Daie �/ <br />Z <br />