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SITE ADDRESS <br />��i��', <br />LEGAL LOTNO. <br />DESC. / _.�_ 1 <br />� cRMIT APPLICAT'► �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 />APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br />�"i/� .�f :-��J <br />, BLOCK <br />PARCEL TAX I.D. # <br />2 %D ��'JID�{l-��D� <br />' OR SUBDIVISION # <br />PERMIT <br />t�vvncrc � s�wrtwo �.n�iur rnvn� � � _„�_��� <br />n(� 1\ (��/� •Y.�-�'��� ".� <br />II IJ.`���T:�.L�� 1'.r•.a��� •�t=.v l..l_<' I�'� 13�}X �Z�% E? in'���� ��Rt��� ` �'•�-� <br />%C� <br />TENANT NAME I CONTACT FOR PERAiIi PHONE <br />E-MAIL <br />VVry1RMl�IVR <br />��•��1�•�;�wi« �,.,1�'� <br />CONTR. LICENSE # <br />S ir},1� <br />USE OF BUILDING <br /><' t- <br />.> <br />WORK DESCRIPTION <br />/VPH.v l'F}�.��, <br />..��..��� ' , �....�.. , ...�..� <br />(?�> h�.., �zti7k: �r1�(/ C?���k ��' �? sU`�•J�ly-c� �y� <br />NO. I TYPE OF FI%TURE OR ITEM <br />�3 Toilel <br />.y_ 021h1ub <br />� Lavatory (wash basin) <br />Shower <br />t Ki�chen sink & disposal <br />I Dishwasher <br />� Clolhes tivasher <br />� lNater heater <br />Sink (service/bar/mop/etc.) <br />Back(low prevenler <br />Urinal <br />Drinkin9 Fountain <br />Floor drain <br />Grcase trap <br />Roof drains <br />Other <br />HEA'f SOURCE <br />Eleclric �Gas Other <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />I Forced air systems <br />� Gas piping <br />� Water heater <br />1 Gas fireplace <br />i Gasrange <br />Clothes dryer <br />J_ Ranc�e hooU <br />�_ Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify thal 1 have read and examined Ihis applicalion and know the same to be true and correcL AI� provisions of Iaws and <br />ordinaces c�overning lhis type of work �vili be complied wilh whelher specified herein or nol. The granting o( a permit does not presume <br />to give aulhority lo violale or canr.el tlie provision of any olher slate or local law regulating construclion or ihe performance of <br />conslruclion. Thal I am aulhorized by the owner of lliis property to perform the work for which applicalion is made and I comply wilh the <br />Sta�e Contraclors Law 76.27 RCW and 296200 WAC. <br />nalure of-OwnerlContractodAuthorized Agent � / Date <br />1�2 <br />