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PtRMIT APPLICATIUN <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />� �. 1 I�� �� ��� ��"�� <br />LEGAL LOT N0. BLOCK <br />DESC. <br />TENANTNAME <br />11�.1PI•:l. ./ �I(.1/ll� i�n i�.• <br />P;IRCEL TN( I.D. p <br />TRACT <br />CONTACT FOR PERMIT <br />( /�iV • I �.� �� L� <br />11 _ . ' .." ( � �.M1 r. : ,i� c... ADDRESS - � <br />, 'y -/ _�?� Av. '�! <br />CONTR. UCENSE ff � - <br />/ `: <br />USE OF BUILDING <br />WORK DESCRIPTION <br />� .5 / r n � . <br />HEATSOURCE <br />Electric Gas Other <br />�-zy`° <br />PERMIT # <br />'� �7�i � "'� <br />PHONE <br />� <br />�-G(. 3��G' �%ti % <br />CITY2IP PHONE <br />1::'., - Zt � .;,�1 -��"j[• <br />�. n <br />` �2 <br />/e[�- <br />CONTRACT PRICE OF WORK <br />�j. Cr'!' . <br />i <br />. �i.-!A// /Va'w �/CA/v i��lwl" !.�F'� �''`%�%y1/�SSio•� <br />NO. I TYPE OF FIJ(TURE OR ITEM <br />Toilel <br />Ba�hlub <br />Lavalory (wash basin) <br />Sl�owcr <br />__ Kilchen sink 8 Aisposal <br />_ Dishwashor <br />_ Clothes washer <br />__ Watorhoatcr <br />_ SinA (s�rvice/barlmoplolc.) <br />Backflow preveMer <br />_ Urinal <br />_ Drinkinp Founlain <br />Floor drain <br />_ Grcase tr�p <br />Roof Arains <br />Othor <br />N0. I TVPE OF FI%TURE OR ITEM <br />A/C - air handlinp unils <br />Forcod air systems <br />Gas pipinp <br />Water heater <br />Gas fraplace <br />Gas rango <br />Clothes dryer <br />Rango hood <br />Exhausllan <br />Hea� pump <br />Unit heater <br />Boller <br />Refdgeration <br />Woodslove <br />Other i" ��r''is..,.�.�.'v,...., <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �f05 <br />I hereby cerilify that I have read and ex..rnined ihis application and know Ihe same lo be �rue and correct. Ail provisions of laws and <br />ordinaces governing Ihis type of work will be compliod with whelher specilied herein or not. The granting ot a permil does not presume <br />lo give authority lo violalr, or cancel the provision of any olher state or local law regulaling consWc�ion or lhe peAormance ol <br />consiruction. Thal I am authonzed by lhe ownar ol ihis property to pedorm the wnrk lor which application is made and I comply wilh lhe <br />Sta�e CoNraclors Law td.27 RCW and 296.200 WAC. <br />• � c . �!:_ I �� 1 �l'(r <br />�IZ <br />