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PcRMIT APPLICATIVN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-25i-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �_ Q I�� <br />SITE ADDRESS <br />��'Vli � <br />'i i � <br />LEGAL LOT NO. BLOCK <br />DESC. <br />OWNER <br />/2 i G�yA/'�16, !, � � <br />�TENANT NAME <br />�l�T/ ��? ti . �.. <br />CONTR. LICENSE k <br />�21�� ��'/fi�� �� <br />USE OF BUILDING <br />(�,,��, �, - <br />WORK DESCRIPTION <br />Lr�� � �G��� y �� � � <br />' PLUMBING <br />NO. I TYPL OF FIXTURE OR ITEM <br />Toilet <br />Balhlub <br />_ Lavatory (wash basin) <br />__ Shnwer <br />Kitchen sink 8 dispos�il <br />Dishwasher <br />_ Cblhes washer <br />Walcn c�aler <br />Sink (service/badmople�c.) <br />Oackllow preveNer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olhor <br />PARCEL TAX I.D. # PER/M�IT q <br />�'�LJ �I C.Y /_ �.ti., Z <br />TRACT OR SUBDIVISION p <br />FOR <br />i <br />___,� /� 3 /3 <br />HEATSOURCE <br />Electric �Gas _ Olhor <br />1iP/�tf��� <br />PHONE /' Z� 75 �j ��s� <br />7 / / <br />� E-MA��� , ytitwti��.o�:�y �' <br />y z ;- 33sy�1a � <br />� S> /ye Cl� 5 f�i�e,�s ���i <br />I CONTRACT PRICE OF WORK <br />fci ; <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC - air handlinc� units <br />�__ Forced air syslems <br />Gas piping <br />W ater heater <br />x Gas lirepl�co <br />Gas rango <br />__� Clothes dryer <br />Ran9e hood <br />Exhausl lan <br />Heal pump <br />Unil healor <br />Boilet <br />Refrigoration <br />Woodstavo <br />Olher <br />CITY OF EVERETT LOCAL SALES TA%CODE IS ]105 <br />I hereby ceritity Ihat I have read and examined this applicalion and know the same to bo true ano correcL All provisions of laws and <br />ordinac�s yoverning this rypo of work will be complied wilh whether specifiod harein or nol Tho granting ol a permil does nol presume <br />to p�ve aulhority to violale or cancel Ihe provision of any olher state or local law regulaling wnstruclion or Ihe perlormance ol <br />cons�ruclion. Thal I am authorized by Iho owner ol Ihis property to pertorm the work f�r which applicalion is mado and I comply with Ihe <br />SIa�i3;Conlnclors 4aw 1H27 RCW �nd 29fi100 WAC. <br />/ <br />_.i;,._ ,//.:; �r� �. <br />