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C� <br />F cRMIT APPLICATIuN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8610 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��. f S /� <br />SITE ADDRESS p0� n; EvtKLTT PARCEL TAX I.D. # PE iT # <br />a4c�'��a����r�r.� �,,;` �GG/-G <br />LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br />DESC. <br />OWNER ADDRE55 CITYlZIP PHONE <br />po�• o�- ��.�,�c1� . p0 t�\ 53� ��:.c���,,NA 9Su�F� y25'-�59-3/6i <br />TENANT NAME <br />(CONTACT FOR PERMIT <br />j'`itl�.'L 5i0?,tv�V <br />--.h1eu.E�.n, �;�u.,� <c��` ;�71a N ^mt✓Pln.s ��on�� <br />CONTR. LICENSE p <br />moG if. 5� «G� r1LL ��j3 // <br />USE OF BUILDING <br />Jb'.C.0 `� � <br />�PHONE d04.-3Y�1'313 7 <br />�.i�nur rnvno <br />�h�CG SzE�F�.,�,uq 425-?93-a�s� <br />��25� x cE�c. ach 3'�`� 393 7 <br />HEATSOURCE <br />Electric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />I.l�STf.t.� �,b��.1 :,cwEf LIN.t' A�..O wh�Er" S�2UIL� <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ Toilel <br />Balhhib <br />Lavatory (wash basin) <br />Shower <br />Kitcher. sink 8 disposul <br />Dishwashcr <br />_ Clolhes washer <br />Water hea�er <br />_ Sink (service/badmopletc.) <br />_ Oachflow preventer � <br />Urinal <br />_ Drinking Fountain <br />Ploor drain <br />Grease Irap <br />Roof drains <br />J_ OlherCcd�n.�� w.�'c.R +St.�.l::_ <br />NO. � TYPE OF FI%TURE OR ITEM <br />A/G - au handling uni�s <br />Forced air systems <br />Gas pipiny <br />Water heater <br />Gas fimplace <br />Gas range , , <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />�oiler <br />Refrigeration <br />Woodstove <br />Other <br />CIT.- OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereb � certily Ihat I have read and examined this applicalion and kno�v the same to 6e true and correct. All provisions of laws and <br />ordinan.es governing ih�s type ol work will be complied with whether specified herein or noL The granting of a permil does not presume <br />to give euttiority lo violate or cancel Ihe provision of any other state or local law regulating wnslruction or the performance of <br />construc'ion. ihal I:m �uthorized by Ihe owner of ihis property to pertorm the work for which application is made and I comply with the <br />State Coitractors La�v 182 RCW and 29G200 WAC. <br />��%��/��,. (� �L�,�f � �-��- l� <br />Signalu e�( Own�oiitracior/Authorized Agenl Date <br />