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PER�IIIT APPLICATION <br />CITY OF EV'ERETT PERMiT SERV!CES <br />3200 CEDAR STREF_T, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITEADDRESS �I��Z- �i� �✓c S-t <br />£tiEL��-T 7 , w.� �j 3'l-oF� <br />LEGAL LOT NO. BLOCK <br />DESC. <br />i-h�YM�-, (j�-U��r <br />TENANTNAME <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />h�...���� <br />��O L �� �S ��� <br />CONTACT FOR PERMIT <br />� � b�12�T7 <br />PHONE <br />/G �-O - i'.' <br />PERMIT # <br />�'1 � f�12 - U <br />uzS>u�6�4� <br />� E-MAIL <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE # /�'1 ����`/ <br />l� <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />� Electric Gas _ Other �' � �C�O. � <br />WORK DESCRIPTION <br />I��P�-fil�� DL() ��CT/'•-!G",' �U27V/��� l3Y fi N-IG.-N �-iHcrCN�y- <br />(a �1 S' f=� a l"' NA c:� <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basi i) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />VValer heater <br />Sink (service/bar/mop!elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease l�ap <br />Roo( drains <br />Ofher <br />NO. I TYPE OF FIXTURE OR ITcM <br />!�__�__/ A/C —air handling units <br />� Forced air syslems <br />� Gas piping <br />Water heater <br />Gas freplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Bo�ler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify thal I have read and examined this applicalion and know Ihe same lo be true and correct. All provisions of laws and <br />ordinances governinc� ihis t e of work will be complied with whelher specified herein or nol. The granling of a permit does not presume <br />to give authority to vic e or c cel the provision of any other state or local law regulating conslruction or lhe performance of <br />cor.struction. That I a authoriz d by lhe ov✓ner of lhis property to perform ihe work tor which application is made and I comply with lhe <br />State Conirectors Law 27 W and 9;?� <br />� 42-?_ -Lolo <br />