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� �:7 ►�i I��,1� �L�_j_�_[�I ►` � <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425•257-8857 - www.everettwa.org <br />APPLICAI'I(�NS ARE ACCEPTE-D FROM 8 AM TO 4 PM �Il�i �� �i G�U <br />SITE ADURESS � o<<CEL TAX I. .# PERMIT � <br />� �:.�� `��; 1�'I, sE ,� �o �1 � a�3oysoo � -,.� -��� <br />LEGA!. LOT NO. BLOCK TItACT ` <br />UESC� �` � Ca--S QV 2— O a <br />OWNER AUDHES$ CITV2IP PHONE Z�� - <br />JL�CC'�7�('1 � �IGYIIC-� ��� > ��' (%l `�L ��ND� �I�6Z�IG ��j(� U�:y� <br />TENANT NAME C�INTACT FOR PERMIT PHONE <br />—+-�—' ' C_r"!c" .Ja���,;��'�� �I..a�- 33v -o�aU�! <br />CONTRACTOR _J(lC��.�f����-� � yy��'y AODRESS ��-_��,.� 3 �,y CITV/ZIP PHONE �-1Zc� _ <br />CONTR. LICFNSE p <br />-- rlt'i i'tIT"D��YI W <br />USE OF BUILDING <br />WORK DESCR�PTION <br />_ �F� � <<,,� <br />NO. � TYPE OF FIXTURE OR ITEM <br />3 Tnilel <br />Z fia�htub <br />._-y_ Lavatnry (wash basin� <br />/ Shnwer <br />7 Kilchon sink 8 Ais�wsal <br />�, Dishwashor <br />Clothns wash�r <br />_ L Water h<�ator <br />. _ Sink (snrvicelbar/moplotc � <br />-- Oack(low prevcnlor <br />Urinal <br />_ Drinking Founlain <br />Floor dr�in <br />_ Grt�ase trap <br />Roof drains <br />Olhor <br />,�' �.> � r • ' <br />__ �ND4! `ib l�io � 30 -�U4� <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Flrr.lric T Gas Olhor <br />CUII <br />� <br />TYPE OF FIXTURE OR ITEM <br />NC .iir handlin� unils <br />Forcr.d air syslrms <br />Gas pipin� <br />W, Ir,n c�ator <br />Gas liroplacc <br />Gas ranc7e <br />Ctulhes drycr <br />Ra�go hood <br />Ezhaust fan <br />Heal pump <br />Unit haa�or <br />Boilar <br />Rolri�oration <br />Woodslovo <br />CITY OF EVERETT LOCAL SALES TAI( COOE IS J10S <br />I horeby curi�ify iha� I have read �nA exnmmed Ihis applicatiun and know Ihe same lo be Irue and correct. All prooisions ol laws and <br />nrdinaces governing this type ol work will bo cnm��lied with whelher spocdiod horein or nol. The granling ol a permit does nol presum� <br />tn �ive a�dhority lo violale or cancel Iho provision ol any nlhor slalo or local law rogulaling construclion or Ihe peAormance of <br />conclruction. That I am aulhorized by Ihe owner of Ihls propeAy �o periorm iho work lor which application is made and I comply wilh lhe <br />Slale Coniractors 18.27 pCW and 29f20U WAC <br />. ` % �ac✓��l I � �I - c�� <br />Signalure n( OwnedConlr odAuthonzed Agent ate I/� <br />