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, <br />PERMIT APPLICATI N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEREif, WA 98201 <br />425-257-8810 — FAX 425-257-SSJ7 — www.everettwa.org <br />SITE ADDRESS <br />Gr. <br />j, �fs''.;,_ �, ., .. <br />LEGA LOT NO. <br />DESC. .r.-. <br />, <br />,�oic::.`•ti :��ic'b' ''.- <br />TENANT NAME <br />. �;��ar <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAl( t.D. # <br />� �CZ •:v%r: <br />BLOCK THACT OR SUBDIVISION N <br />._ R �; -, u- pP:,:. ,. <br />_ . . -c:..- .. . . <br />ICONTACTFORPERMIT <br />t, � ` � S,� "�:' �=- A <br />CONTRACTOR ^"� <br />-,-; � <br />CONTR. LICENSE �� � �� �.� �'� <br />USE OF BUILDING <br />• 1� <br />PERMIT N <br />:V::f£" ''. <br />?3g--12 AVGU� <br />�r�tt.�, 9812� <br />HEATSOURCE <br />_ Eleclric � Gas _ Other <br />WORK DESCRIPTION <br />� %�\ �' , ^,: -: r. <br />N0. I TYPE OF FlI(TURE OR REM <br />! Toilet <br />BalMub <br />Lavatory (wash basin) <br />� Showcr <br />I Kilchen sink 8 disposal <br />Dishwashcr <br />t Cbthes washer <br />� Water healer <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Fioor drain <br />Greasc lrap <br />Rool drains <br />Olher _ <br />/• <br />...�liq. �J�. <br />PHONE _ ry <br />E-MAIL� c., �..Tfpy,.N:. <br />�� -77�.3�-,`_ <br />� z -/ / <br />CONTHACT PRICE OF WORK <br />NO. I TYPE OF flXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Z Waler healer <br />Gas (ireplace <br />Gas range <br />I Clolhes dryer <br />� Rangehood <br />1- Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilily that I have raad and examined lhis application and know lhe same to be true and correcL All provisions of laws and <br />ordinaces goveminc� tliis rypc of work will be complied wilh whether specitied herein or noL The granting of a permit does not presume <br />lo give authorily to vio�ate or cancel ihe provision ol any olher slale or bcal law regulaling consWclion or the performance of <br />consWctio . That I am a::!horized by the owner of this property lo perform the work (or which applicalion is made and I comply with t6e <br />Sla�e C i asler�5l�w 18.27 RCW and 296.200 WAC. <br />/a Dal o� �� <br />