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rERMIT APPLICAT�JN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVGRETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — w vw.everettwa.org <br />�75 �� APPLICATIONS ARE ACCEPTED FROM 'i AM TO 4 PM ��. G, � 9 <br />SITE ADDRESS y'G PARCEL TAX I.D. # PER <br />��'l 7— �1� S� �2�GS/,ra�z.o?6Oo ,���C%�/0 <br />LOT NO. � BLOCK I TRACT OR SUBDIVISION p <br />�% /"�.r��, � <br />TENANT NAME � <br />f��e <br />o�rr �r�J� <br />CONTRACTOR � /I <br />q �hC� C,Gn <br />CONTR. LICENSE t! <br />USE OF BUILDING <br />C���e <br />WORK DESCRIPTION <br />HG <br />�"7/7 7 �/j,� S� <br />CONTACT FOR PERMIT <br />�;�,� cA�� <br />ADDR� <br />?i lG} l3�� <br />HEATSOURCE <br />_ Eleclric _ Gas _ Other <br />Cp N ve� �a„� !'e •�o�rP / d�J'ccs - <br />NO. I 7YPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (servicelbadmop/elc.) <br />Back(low prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Rooi drains <br />Olher _ <br />�_� G�4 9FJE <br />PHONF. !/� �j—�CO <br />F.MAII iis��strMn�d+l/inc�dj. <br />r��r ��zs 3SS s-s`D <br />CONTRACT PRICE OF WORK <br />cb <br />/�, o�.._ <br />NO. I TYPE OF fiXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler healer <br />Ges (ireplace <br />G�s range <br />�:lolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodslove <br />Olher <br />CITY OF EVERETT LOCP.L SALES TAX CODE IS 9105 <br />I hereby ceritify thal I have read and examined this application and know Ihe same le be true and correcL All provisions of laws and <br />ordinaces c�oveminy this typ� o( work will be complied with whether specified herein cr noL The granling of a permit does nol presume <br />to give authority lo violate or cancel lhe prcvision o( any other stale or local law regulaling construclion or the periormance of <br />construclion. Thal I am aulhorized by tlie owner o( this property to perform ihe work (or wh�ch application is made and I comply with the <br />Sta� Contrectors Lavy, 1{�.77 RCW and 296.200 WAC. <br />/'y'Oc� <br />Date <br />i� <br />