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PEr�MIT APPLICATION <br />(;ITY OF EVERETT PERMIT SFRVICES <br />3200 CEDAR STREET, EVERETI", WA 98201 �1�15/Z -C�4D <br />425-257-8810 - FAX 425-257-8857 - wv✓w.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� 7/Z� <br />SITE ADDRESS � PARCEL TAX I.D. # Af'�( �S� y�p y, Z_ v'SpEORMIT`#f <br />5�0� F'— 1��2. I1J F� 2oo�'ioozs�os <br />LEGAL LOTNO. BLOCK TRACT� /=dLZOUS��7Z70j$J TR� �0 LpJyo�•p6Z-pCiS— <br />DESC. Z 3 <br />L11K-EL,Q�n N��nr.S �i��- po./$-;K' E'�y�4 [�-SitZt=»1 �C�SY y�i 35G �7G7 <br />TENANT NAME CONTACT FOR PERMIT <br />'' � ST�</� C�1 i4�G 5� S <br />j <br />CONTRACTOR Li4i�� � ,� ADDRESS <br />4 D �fu,rr s ��c. <br />CpNTR. LICENSE # <br />L�4(�CL�1 Gu� JL <br />USE OF BUILOING <br />S<,� <br />WORK DESCRIPTION <br />��.� 57�^U C 7 /t, �"1 <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sinh & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />BackOow preventer <br />Urinal <br />fJrinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />��.o - i��x �`y�5'.1. , <br />c. S7c1�'ci��s, L��1° �I� <br />HEATSOURCE <br />Eleclric � Gas _ Olher <br />ur Z�� � H� <S� �� <br />� NO. I <br />CITYIZIP <br />t •�. <br />� ZS �' <br />PHONE <br />yzS 35(. �7.G7 <br />PHONE <br />� �'zS.35� > > G 7 <br />CONTRACT PRICE OF WORK <br />7 <br />'i�i'3r- �/ )L�i �.C✓ f/ �� <br />�`i <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systerris <br />Gas piping <br />Water heater <br />Gas f replace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined lhis applicalion and know the same lo be true and correcl All provisions of laws and <br />ordinaces governing lhis type of work will be complied with whelher specified herein or nol. The granting of a permit does nol presume <br />to give aulhority to violate or cancel the provision of any olher state or local law regulating consWclion or Ihe performance of <br />wnslruction. That I am aulhorized by the owner o( lhis properly lo perform lhe work for which applicalion is made and I comply with the <br />State Conlrac.tors Law 18.77 RCW and 296.200 WAC. <br />