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Q�.RIMIT APPLICATIG.d <br />CITY OF �VERETT PERMIT SERVICES <br />3200 CEDAI� STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www ev�rettwa.org <br />, APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTE D <br />�, SITE ADDRESS y� I PARCEL TAIi I.D. p PERMIT t! <br />1� ��,� � 5���-� � dC�s37y-ct0o.�yy-� E c�so�-r�=�� <br />'� I I:-GM� LOT N0. � BLOCK TRACT <br />� f <br />UESC-I__�L�-'�rolLy _ _ ___— _- - .- �\,/ {.-. ._�.:�.. L _�. ;.I <br />�� <br />TENANTNAME <br />a <br />I - <br />� CONTRACTOR ,� <br />�' (��(����tTj /`Ii�AN'uJ =Sr�(� <br />j CONTR. L�ICENSE p , <br />---L� �-4�/ /�� !� S <br />I USE OF �UILDING <br />� �� ���1 <br />j WORK DESCRIP?ION <br />I <br />� NO. <br />%/��_ �/�n �Si:�_%� r�� <br />CONTACT FOR PERMIT <br />A��RESS qTV/ZIP <br />J 4 �w-Q <br />HEAT SOURCE <br />_ Eleclric� Gas _ Olhor <br />--��-/—�� --1.Y) ,"� J ic <br />PLUMBING <br />IYPE OF F:�(TURE OR ITEM <br />', 'i T��tlnl <br />� � b.�lhlub <br />I .� Lavalury (wash b�sin) <br />Showrr <br />% Kilchen sink & disposal <br />'. i Dishw�shur <br />' � Clolhec�vosher <br />. � I.aunJry �ray <br />,___ Sink�;;ervico/badmop/olc.) <br />_ Bar.hllow �?roven�er <br />Urinal <br />i _ Drinkin9 Fuuntem <br />' Fluor drain <br />_, Greasc trap <br />Roof drains <br />Ulher <br />j[ � ".15 Z ' <br />PHONE <br />PHONE <br />CONTRACT PRICE OF WORN <br />/ �lC_� U <br />-L� � S " <br />MECHANICAL i <br />� �70. I TYPE OF FIXTURE OR ITEM , <br />A/C - air handlmp units <br />Forced air systems <br />Gas piping <br />Watcr hoaler <br />Gas Greplace <br />Gas ranc�e <br />Clothes Aryer <br />Ranye hood <br />Exhaust fan <br />Heat pump <br />Unil healcr <br />�oiler <br />Relrigera�ion <br />Woodstove <br />CITY OF EVERETT LnCAL SALES TAX CODE IS 9105 <br />I hereby ceri�ily that I have raau and eaamineA Ihis applic�tisa ancl knuw the same to be trur, and wrrecl. All provisions of laws and <br />„rJinaces �,7overninp Ihis �ypu ol work will be cumplied with nhethur specilied herein or not. The granling ol a purmit doos nol presume <br />W give aulhority t� violale or r.ancel Iho pwwsion of any othor stato ur local law rec�ulaling construclion or Iho poAurmance ot <br />��onstruchon. That I aim awihorizad by iho ownnr ol this property lo pertonn ihe work for which application is made and I comply wilh ihe <br />;��tnte ConlrayJlors I.aw 18.27 RCW m7y1 2!�G2U0 WAC. • <br />/ � <br />� �+- r/2 �'-/�S <br />Sn�nal�l0� onVac�od ulhor�� . yent ato 1/� <br />l� <br />