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SITE ADDP.ESS <br />� 1 i (� ct -r i, <br />LEGAL LOT N0. <br />DESC. ' Z <br />PERIIIIIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereltwa.org <br />APPLICATIQNS AFZE ACCEPI'ED FROM 8 AM Tq 4 PM <br />BLOCK I TRACT <br />PARCEL TAX I.D. # <br />�—'�Li=l-.4ni ,t7 1�v.vt.cc� �vl c. i^(.' iJ:,�( ���Iv L�� <br />TENANT NAME CONTACT FOR PERMIT <br />. i� � L.V` l.V �4 r� l3 � S <br />CONTRACTOR L,n.���_��� I�,.��,y���� � „ADDRESS <br />CONTR. LICENSE #�� ��` `�i i U� ;�` <br />USE OF BUILDING <br />� �i� <br />, )� �� ���?� <br />��� <br />!T # <br />vur rn�wc ��� <br />S�c✓J•..S , ��sZ�Y ?S� <br />FHOkE <br />.�Li �i"4; 7�C:7 <br />CITY2IP PHO�E <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />[leclric i�Gas Other <br />WORK DESCRIPTION <br />��:,� �,�,:�.-,,��;% ��= z��� � s�r�� 6�s�� t-� <br />��� <br />NO. I TYpE OF FIXTURE OR ITEM <br />:i Toilet <br />�Balhtu6 <br />Lavatory (wash basin) <br />Shower <br />� Kilchen sink 8 disposal <br />1 Dishwasher <br />� Clolhes wa�her <br />_ Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roo( drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />I Forced air systems <br />`I Gas piping <br />� Water heater <br />� Gasfreplace <br />i Gas rangs <br />I Clolhes dryer <br />�Range hood <br />Exhausl fan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TlJC CODE IS 3105 <br />I hereby cerilify lhal I have read and examined this applicalion and know the same to be lrue and c orrect. All provisions of laws and <br />ordinaces governing this type of work will be complied with whelher specified herein or nol. The granting of a permit does not presume <br />to give aulhority to violate or cancel lhe provision of any olher state or local law regulating construction or the performance of <br />construction. Thal I am authorized by lhe owner o( this property to per(orm lhe work for which applicalion is made and I comply with lhe <br />State Conlractors Law 1827 RCW and 296.200 WAC. <br />_s i�/�+/�'S <br />Date �/ <br />a <br />:� <br />