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P�RMIT APPLICATIC�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - F,4X 425-257-8857 - www.everettwa.org <br />APPIICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # <br />-��:3/ Scfi-�f�.'2si �vE= <br />LEGA LOT N0. BLOCK TRACT OR SUBDIVISION p <br />DESC. <br />OWNER ADDRESS <br />�JCCJC�/�C7UOi� <br />TENANTNAME CONTACTFORPERMIT <br />,cU�3�•�.5v�✓ <br />CONTR. LICENSE t! <br />,�O/d�n/P � <br />USE OF BUILDING <br />s r-2 <br />i�ERMIT / <br />�' �io6 -00-7 <br />PNONE <br />i�L L:JII�ji�.0 / N L rw.....v..a /�-%I a-rN(�./'UnJ '_ <br />a933v �1�try si��r n�c 36v- Yv3' 7t�62 <br />L L <br />WORK DESCRIPT�ON <br />/,•�STA[� F,�zc <br />�ATSOURCE <br />Eledric _ Gas Other <br />S �/Z iNK LL� %N <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washcr <br />Water heater <br />Sink (service/barfmop/elc.) <br />Backflow preventer <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grease trap <br />Rool drains <br />Olher _ _ _ <br />CONTRACT PRICE OF WORK <br />� S� � J-v <br />N L�v S �/e <br />NO. I TYPE OF FUCTURE OR ITEM <br />� AIC — air handling units <br />Forced air systems <br />Gas piping <br />Walcr heater <br />Gas (ireplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />S /LrJK.LL-372 /-�C'¢t7S <br />CITY OF EVERETT LOCAL SALES TA7( CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this applicalion and know the same to be lrue and correct. AII provisions of laws and <br />ordinaces yoverning this lype o( work will be complied wilh whether specified herein or not. The granting of a pertnit does nul presume <br />to give authority to violate or cancel the pr�vision of any olher state or local law reydlaling consUuction or the peAortnance of <br />consiruction. That I am authorized b Ihe owner of Ihis property to peAorm the work for which application is made and I comply with the <br />State Cpntrar,tors,Law 1827 RC ai 1 296.200 WAC. <br />�(Z <br />