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P�RMIT APPLICATIG�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - wvvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />5'3D 3 <br />LEGA LOT h0. <br />TENANTNAM[ <br />CONTRACTOR <br />L�e�'IY�U f �- <br />BLOCK <br />CONTR. UGENSE # � � f' � � C ^ � / �, <br />%', �> 4 <br />USE OF BUhDING ----'' ' <br />----.– —I - <br />WORK DESCRIPTION <br />PARCEL TAX i.D. ii PERMIT # <br />Ca Y 5 S,P vo � oo S 1.S U��' <br />TRACT <br />S 3 �3 l,v�%1�rna <br />CONTACT FOR PERMIT <br />n1;14 G��/��� <br />3S 3 - 07 Z. <br />PMONE <br />`lzj -��,��' -5iv�l <br />CITY2IP PHONE <br />` )�7.�5_ . <br />P � � - 9z �i ,�/ /3� ` s�w-H� �� ��Z. 3 <br />' HEAT S�} U�/� E CONTRACT PRICE OF WORK <br />_ElecMc _Gas� Olher � 1� �uV <br />f.ie �Nc � � �,:lr 4y [. <br />NO. I TYPE OF FI.YTURE OR ITEM <br />Teilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbarimop/etc.) <br />Backflow preventer <br />Urinal <br />Dnnking Fountain <br />Floor drain <br />Grease trap <br />Roc( drains <br />Olher <br />✓ / <br />Cu��� %��� � G�aa.l 1'i��l•k� <br />l•� � ✓. <br />NO. I 'fYPE OF FIXTURE 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 />Ciothes dryer <br />Rangehood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeraticn <br />Woodsrove <br />Other <br />CITY OF EVERE7T LOCAL SALES TAX CO�E IS 3'105 <br />I hereby ceritify that I have read and examined this appiication and know the same to be true and correct. All provisions ot laws and <br />ordinaces governing this type cf work will be complied with whether specified herein or not. The grantin� ot a pertnit does not presume <br />to give authorry to violate or cancel the provision of any other state or local law regulatinn constructiun or the performance of <br />constructior. Thai I am authorized 6y the owner of ihis preperty to perform the work for which application is made and I comply with the <br />State Contractors Law39.27 RQW and 296.200 WAC. <br />�z <br />