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PERMiT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — �AX 425-257-8857 — www.everettwa.org <br />SITE ADDRESS � �j�`f 2 � �' <br />�Yc�,�G'r� Gill� <br />LEGAL LOT NO. � <br />Ko�,�r <br />TENANTNAME <br />APPLICATIONS ARE ACCEPTED FROM 5 AM TO 4 PM �� �-�(,� <br />AJC w <br />� �i I�v 7 <br />BLOCK <br />; C���r 5�� <br />� Cc�u�`� <br />PARCEL TAX I.D. # <br />�)L� <br />TRACT OR SUBDIVISION M <br />,_._ , _..T ,_.._. . <br />CONTACT FOR PERMIT <br />. <br />, <br />,�Ex>�U .�. u�„— <br />CONTRACTOR ��! M ^�, V j�U3/�S <br />CONTR. LICENSE # G�n � U i� ��Oc� (� k <br />USE OF BUILDING <br />����nL'�� : i;v� <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />''S Toilet <br />Z. Bathtub <br />j �Lavalory (wash basin) <br />Shower <br />� Kitchen sink & disposal <br />_� Dishwasher <br />i� Clothes washer <br />�'Z� Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease irap <br />Roof drains <br />Other <br />�`I �-7 /���%�G 5�= <br />HEAT SOURCE <br />_ Electric _ Gas _ Other <br />PERMiT # <br />G�� �zs) �iG�7-S�zz <br />PHONE L7''2,�,� ��j � <br />�z`�j��l.�S�>� <br />CON7 RACT PRICE OF woRK <br />���(;���r�, oD <br />NO. I TYPE OF FIXTURE OR ITEM <br />� A!C — air handling unils <br />Forced air syslems <br />� Gas piping <br />Water heater <br />� Gasfreplace <br />� Gas range <br />� Clothes dryer <br />� Range hood <br />� Exhaust fan <br />Heat pump <br />Unil heater <br />Boiler <br />� Retrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinances governing this lype of work will be co�nplied with whelher specifed herein or not. The granting of a permil does nol presume <br />lo give aull�ority to violate or cancel the provision of any olher state or local law regulating construclion or the performance of <br />cons�ruction. That I am authorized by the owner of this property lo pertorm ihe work forwhich application is made and I comply w�lh �he <br />State Contractors aw 1,8. 7 RCW and 296200 WAC. <br />; �,��- G�,-� " ,�l/�� . <br />Signalure of OwnedConlractor/Aulhorized Agent Date /� <br />