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PtRMIT APPLICATICiN <br />CITY OF EVEFcETT PERMIT SERVICES <br />3200 CFJAR STREET, EVERETT, WA 98201 <br />425-257-381(� — FAX 425-257-8857 — www.everettwa.org <br />APPLIGATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SfTE ADDRESS <br />���?,�.C,-��th �L, ��l• t v�r���� �. <br />BLOCK <br />�- <br />.���.,,�j ,�.,i7�ncil� <br />TENANT Ni�ME <br />�ARCEL TAX I.D. # <br />(0�8300001.��%n <br />TRACT OR SUBDIVISION # <br />6-as- � <br />� t ) J���� —�?�� <br /># <br />�jt�Jo _qr.�.�L. c�. �i,Sr�-�+ iJ tv�t 9�dvy NZS=�NN-o7 <br />CON7KAl:IVK ,i���,���c� �.NS�Tu��1Jn/ <br />�'�,�.,oAsylNv <br />CONTR. LICENSE # � � _ _ _ <br />USE OF BUILDING <br />r���« <br />CONTACT FOR PERMIT <br />.�- <br />'��7JS �-CNi7LAI:.tFt- <br />Srv;7Hca-SN ���c16 <br />HEATSOURCE <br />�"���_�� �,� 7� Eleclric _Gas_Other <br />WORK DESCRIPTION <br />:_llp—o,,, i� K�Zrr%/�i��Nin�6i�H� <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />E3athtub <br />Lavatory (wash basin) <br />Shower <br />Kitclien sink R d�sposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (serviceNadmop/elc.) <br />6ack(low prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Olher <br />PHONE (�J-�"'�yH—U 7� <br />E-MAIL _ i f�Yl M(�''E'��� N <br />,2oG S�"o-9�99 <br />CONTRACT PRICE OF WORK <br />(,�SS 7ArW -�.�� Ooo. �o <br />�,�a�-� ,�� rC�sS✓� 1n.�) !�A D -t�✓ 1?,4�'�w/�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air syslems <br />Gas piping <br />W ater heater <br />Gas tireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust(an <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined lhis applicalion and know lhe same to be Uue and correcl All provisions o( laws and <br />ordinaces governing this type of work will be complied wilh whelher specified herein or nol The granting o( a permil does nol prosume <br />lo give aulhoriry lo violate or cancel ihe provision of any olher slale or local law regulating construclion or the performance of <br />conslruction. Thal I am authorized by lhe owner of lhis properly to pedorm lhe work for which application is made and I comply with lhe <br />State C ntract°fs Law� 1�8�. A RCW and 296.200 WAC. <br />i� �-1��+'�L%� 10-1—�9 f, <br />,Signalure of OwnedConlractor/Authorized Agent Date I� <br />