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SIT[ ADULR/ESS � <br />LEGA L T NO. J« <br />TENANT NAME <br />P�:RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STf:EET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.ew�retlwa.org <br />APPUCATIONS ARE ACCE�TED FROM 8 AM T�� 4 PM <br />PARCEL TAX I.O. # <br />�ls���` O�� l� <br />BLOCK I TP.ACT <br />CONTACT FOR PF.RMIT <br />�b �,:��, <br />CONTRACTOR ��-� s'��/ AUDRESSp � <br />nn �y / /y � 0,�� I✓PuC� ��t B <br />CONTR. LICENSE p y p.� C I //l 7�Q � l� ��/' <br />` �'J cly �l � C.i <br />USE OF BUILDING <br />��� A�•.�_N�fi/� il[G <br />WORK DESCRIPTION <br />NO. I TYPE OF FI%TURE OR ITEM <br />l oilo' <br />�alhtuL <br />Lavatory (wash basln) <br />Sh� �er <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washor <br />W ator hnator <br />Sink (sarvlce/badmoploic.) <br />Beckllow pravonlor <br />Urinal <br />Drinklny f-oun�aln <br />Floor drain <br />Groasa lrap <br />Roof drains <br />Other _ _ _ <br />HEATSOURCE <br />__ [Icclric � Gas ___. Othor <br />PERMIT # <br />C G ) 0 � � u0`) <br />PHONE <br />. ��'7s�f� �? y� <br />CITY2IP PHONE <br />m�,,�sv,i�� v� �b'o' I��O <br />9 �1�0 <br />CONTRACT PRICE OF WORK <br />r��%'�i�%�'i�i <br />l�5 � �3 � <br />MECHANICAL <br />NO. I TYPE OF FIXTUNE OR ITEM <br />A/C - eir handling unils <br />Forced alr systems <br />Ges plpinq <br />Wnlor hoater <br />Gas firoplace <br />Gas rango <br />Clolhes dryor <br />Range hoad <br />Exhaustfan <br />Heal pump <br />Unit hoater <br />Bailer <br />Refrigerallon <br />Woodstove <br />CITY OF EVERFTT LOCAL SALES TAX CODE IS 7105 <br />1 hereby corilily Ihal I have rsad and examinod this a{,pli�alion end know lhe same to bo true and cortecl. All provlslons ol lews and <br />ordinaces govoming Ihis l� on ol work wlll be complied wilh whether specified heroln or nol. The granling ol a permil does not piesume <br />to givo aulhority lo violate or cancel Ihe provlsion of any othor slate or local law regula0ng conetrucUon or the perlormance o( <br />coislruction. That I am amhorizod by lho ownor of this property to perform the work for which eppiicellon Is mede end I comply wllh lhe <br />Stqlo C r, 1f7.27 RCW and WAC. <br />��/�`�°°� ,�/�/o� '�1 <br />Signalure ol OwnedConlraclodAulhonzed Agent Date <br />