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l <br />w�RMIT APPLICATION <br />CIYY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />,'••PPLICATIONS ARE ACCEPT[D FROM 8 AM TO 4 PM <br />P��51) �Ol I <br />SITE ADDRESS PARCEL TAX I.D. # P cMIT # <br />�L 1 ��--� , .✓� <br />Sc., P� � W zoo' i oo z o0 <br />LEGA LOT NO. BLOCK TRACT <br />DESC. � �� _ _ _ <br />OWNER pDDRESS CITY2IP PHONE <br />LAt'.cc.a�o I��,,�'LS 7nc i'�, b:;x gY� [,(�. S«✓�NS y,3-zS3- <br />/ <br />yZr <br />3Sc, -�7 G � <br />TENANTNAME CONTACTFORPERMIT PHONE <br />I S�`u� i�.,�2d�S �/zs 3s� ��C�� <br />CONTRACTOR („N���,�N� ���` �.��,�� ADDRESS CITY2IP PHONE <br />� �� . s�x ��� � <br />CONTR.UCENSE# L',K-t=L.H 1 C'.�'� ��— �k� S �<UL-!J$' Ct{ ZS�' `�ZS'35G-%7G � <br />USE OF BUILDING <br />S r� <br />WORK DESCRIPTION <br />HEATSOURCE <br />_ Electric � Gas _ Other <br />CONTRACT PRICE OF WORK <br />C�,�S-r,f�::-r�an/ or 2U �I� t.� Sr rc r3As�C ��3i <br />NO. I TYPE OF FIXTURE OR ITEM <br />7 � Toilet <br />Bathlub <br />� � Lavatoq• (wash basin) <br />�� Shower <br />i Kilchen sink & disposal <br />� Dishwasher <br />_L Clothes washer <br />_ Laundry tray <br />Sink (service/bar/mop/etc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />_L Forced air syslems <br />`I Gas piping <br />I Water heater <br />� Gas fireplace <br />� Gasrange <br />� Clothes dryer <br />� Range hood <br />+,� Exhau�tfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify thal I have read an�+ �xamined this application and know the same to be true and corcect. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to vioiate or cancei the provision of any other state or local law regulating construction 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 />Stale Contractors Law 18.27 RCW and 296.200 WAC. / <br />Ss ��'�✓L•- , G�r�c li I � � I os <br />�/v <br />