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PL�tMIT APPLICATIG.J <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 ACCEPTCD FROM S AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. p <br />� <br />I I'�IO �"` /iv�> •�f- 0`,�7 (o Oc�� G <br />LEGA LOT NO. �BL"OCIF TRACT OR SUBDIVISION # <br />oesc. .�Ct^,i i>(�'� Lr,y N� ,.._.,,.,� <br />" . ��,l��i�y� rt I�\��_�f�1 <br />TENANT NAME <br />Zc6RTiiAC�— ----- -- <br />� ,��, i. (�,�-,��<<,� � ,� , � <br />CONTR. LI�ENSE M <br />� � '� n r (., lC \> — <br />USE OF 8 ILDING <br />. �,.: ' T: .I�. <br />WORK DESCRIPTION � <br />. ,� �; ��-�.� <br />f:C�7 <br />� L� l 1 i 111 'S1 :, E <br />CONTACT FOR PERMIT <br />'1-� �2�z , �,,,��r �1 •�p� <br />TYFE OF FIXTURE OR ITEM <br />j� Toilet <br />_� Da�hWb �. <br />� ��_ Lavatory (wash basin) � � <br />i�� Showei � <br />�_ Kilchen sink & Aisposal <br />J Dishwasher <br />� Clolhes washer <br />�.. Waten c�ater <br />J_ Sink (service/bar/mop/e�c.) � <br />�_ �ackllow preventer <br />Urinal <br />Drinkin9 Fountain <br />1_ Floor dram <br />Grease Irap <br />�_ Roof dra�ns <br />Other <br />HEATSOURCE <br />'� Electric �Gas _ Olher <br />�- 8-1 D <br />PERMIT f! <br />� /� _ %,� <br />�� , <br />PHONEyL$�- 3vC�-Q�c � <br />t-mli�l l,n.�ni.....,ii r�'.,..... <br />1TV1YI�— c f�FiaR� 3 4G -.�u % I <br />��,,�,n �L,� `,d'�,`, <br />CONTRACT PRICE OF WORK <br />N0. I TYPE OF FIXTURE OR ITEM <br />1 NG - au nanc'ing unns <br />� Forced air systems <br />��-,�_ Gas piping <br />. �Water heater <br />_ Gas fueplace <br />�_ Gas range <br />�_ Clolhe� dryer <br />_ �_ Range hood <br />�_� Exhausl fan �7� <br />� Heal pump <br />Unit heater <br />E3oiler <br />Relrigeiation <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />I hereby certify tha� I have read and ezamined this applicalion and know Ihe same to be irue and correcl All provisions of laws and <br />ordinances yoveminc� �his lype ol work wil� be complied with whelher specified iierein or no�. The gran�ing of a permit does nol presume <br />Io give �ulhonty �o violate or cancel Ihe provision of any other s�ale or local law regulating conslruction or ihe performance ol <br />conslruchon. �Riat I am author¢ed by Ihe owner ol ihis property to perform Ihe work for which application is made and I comply with ihe <br />Sla�e Coniractors Law� 18 27 RCW antl 29�200 WAC <br />� � � S-n� %'//.' I <br />;ignAlur b,�wne Conlrador/A rized Agent Datc �� / <br />ii � l Z <br />_ _ _— _ --- <br />_ cE ��Fa Q� <br />,y <br />