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P'�RMIT APPLICATI(�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />� Z`�>—�� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />�`"j0,; %�Se� %�ne <br />LEGAL LOT NO. BLOCK <br />DESC. <br />OWNER <br />�'/�' /�.�/6�r- <br />PARCEL TAX I.D. # <br />TRACT <br />fiC'3 /�ur�t���•�ir� e � � <br />z- <br />y�� = <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />� � �a�yJC� � r�/�e/!�P/^ l / ���.5� 6.�.1 �j-- <br />CONTRAqCTOR ��� ADDRESS CITYIZIP PHONE �`�� 37_ <br />CONTR I� SE�!'l �; �� � n�' /36/8- yi ��,�e. N,e" �'�if�i��e �60 9/ <br />9r���i �s�3 <br />USE OF BUILDING/ — HEAT SOURCE I CONTRACT PRICE OF WORK <br />%'����'T�- ��ir/� ElecMc Gas XOther D�� �� Zli,7%•OoG./�y �ir,ti� <br />WORK DESCRIPTIO�N�r� �Pcfe� <br />/"I�:Y.Si/�n c4��1"/S7;�G -Fur�oc» <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mopietc.) <br />Backflow preventer <br />Urinal <br />Orinking Fountain <br />Floor orain <br />Grease trap <br />Roof drains <br />Other <br />/ �i � <br />� _�t�v//-�`.r/eul� 7'�ir,tx� <br />i <br />NO. I TYPE OF FIXTURE OR ITEN, <br />A/C - air handling units <br />,—�t Forced air syslems <br />Gas piping <br />N�ater heater <br />Gas fireplace <br />Gas range <br />Cicthes dryer <br />Rangehood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove ' <br />� Other 9 � u/Y10�e— <br />CIN OF EVERETT LOCAL SALES TAX CODE IS ]'105 <br />I hereby ceritity that I have read and examined this application and know the same ro be true and correct. All provisions of laws and <br />ordinaces gnveming tnis rype of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authonty to violate or cancel the provision of any other state or local law regulating constriction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 1E.Zi RCW and 296.200 WAC. <br />., ��z.(� ��i�f�-��--- /���/3� � <br />