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P�RMIT APPLICATIGN <br />CITY QF EVERETT PERMIT SERVICES <br />32G0 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />51TE ADDRESS PARCEL TAX I.D. # <br />�q.3v �f9�� s % sw 290439G�'�f�5�� <br />LEGAL LOT N4. BLOCK TRACT OR SUBDIVISION # <br />DESC. � S.E/�6'PEI�Z� <br />SDu��1 �'�i�cL �i✓t/OS�iI'1� <br />TENANTNAME <br />Y V I� 1 n11V 1-JI� <br />c,_ yr�� y rt,,,r,•es ti� r�„� <br />CONTR. LICENSE # <br />l-t-�,4c H•vot� y i?K _ <br />USE OF BUILDING <br />N�u% <br />S;,kiCc F/�.�, �c. <br />S Lql<C .S��P.,�s �P <br />CONTACT FOR PERMIT <br />SGO!/ �%I�'��'(`j • <br />D RE S <br />l �OC $ ��C�S%P<lP��sF•fi :. <br />���i� , ' �k�s <br />HEATSOURCE ' <br />_ Eiectric � Gas _ Olher <br />WORK DESCRIPTION ' <br />t3t.���c� �,�c�� a s��.2y �drne <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel i \� <br />Bathtub \ \ <br />Lavatory (wash basin) � 4 � � <br />Shower � <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer � <br />Water heater <br />Sink (service/bar/mop/elc.) <br />BackFlo�v preventer <br />Urinal <br />Dr;nking Founlain <br />Floor c rain <br />Greas�, trap <br />Roof drains <br />Other <br />PHONE .:�(aS�ai�3/—�B�Q <br />CONTRACT PRICE OF WORK <br />�r <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />1_ Forced air systems 1 <br />�_ Gas piping <br />L_ Water heater 1 <br />� Gas fireplace � <br />Gas range <br />� Clalhes dryer 1 <br />�Range hood <br />Exhaast fan � I l � <br />_ Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />I Other _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined lhis application and know the ^ame to be lrue and corre-L All provisions ot laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting ot a permit does not presume <br />to give authorit�� lo violale or cancel lhe provision of any olher state or local law regulating construction or the performance of <br />construclion. That I am authorized by lhe owner of this properly lo pedorm lhe work for which appiicalion is made and I comply with lhe <br />State Cont xlo:s Law 18.27 RCW and 296200 WAC. <br />�-- �-�- o •> <br />S' nalure o( Owner/Conlractor/Aulhorized Agent Oale / <br />I� <br />, :'�-Z9�� <br />