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P_.RMI� �►PPLICATIC..� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-481 U- FAX 425-257-8857 - www.everettwa.ory <br />APPLICATIONS ARE ACCEPTED FROM 0 AM TO 4 PM - DEBIT 8 CRFDIT CARDS ARE NOT ACCEPTED <br />I SITE ADDRESS �� _ PARCEL TAX I.D. # PER�AIT p <br />_�1;�-_11-� , S�C._� ����s3)y-vv�,.�yy� v F Coso�n-o`l3 <br />L[�;%�� LOT NO. BLOCK TRACT <br />UESC n� " <br />iI �,-�{,�, �iy� ,,�• ,!., , I �, / <br />OWNER ADDRESS CITV/ZI � PHONE <br />L1 <br />! TENANTNAME <br />� <br />I�CONTRACTOR / <br />����/�y' ) f � / ��./'%1`✓'I T�p7� <br />CONTR. L�ICENSE N <br />� � �t_4�:�i%7� d �T <br />� USE O�UILDING <br />-- -- 1—�—/�-- --� <br />I WORK DESCRIPTION <br />NO <br />- S �/_/< <br />PLl�M81NG <br />TYPE OF FI%TURC ON ITEM <br />_�'�c ✓o , <br />CONTACT FOR PERMIT <br />ADDRE55 <br />J 4 �� <br />HEATSOURCE <br />_ Geclric� Gas _ Othor <br />J� � t_ i �.. -�-�� � <br />i Todot <br />� j U,ilhtub <br />'� f Lav,dury (w,ish basin) <br />Shovror <br />� Kilchen sinA 8 disposal <br />'. i Disliwash�r <br />' � Cluthes washur <br />�� T Laundry Uay <br />� Sinh (service�bar/mup/etr,.) <br />'� �acAllow provontor <br />Urinal <br />Drinking Fountnin <br />� Floor drain <br />Grease trap <br />Rool drains <br />i � _ Olhf!r ---_ -_ <br />NO. <br />CITV/ZIP <br />y�� -IS-Z- <br />PHONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />�S lC� u <br />M'ECHAiJICAL <br />TYPE OF FIXTURE OR ITEM <br />NC - air handl�ny �mits <br />/ Furced air syslems <br />_� Gas piping <br />_/_ Watun c�aler <br />_L Gas fireplaco <br />G�sr�nc�e <br />�Clolhes dryer <br />Ranc�o hood <br />Exhauslf�n <br />_ Heat pump <br />Unil healer <br />Boiler <br />Ro�ri�oration <br />Woodstove <br />Olher <br />CITV OF EVERETT LOCAI SALES TA% CODE IS 7105 <br />I hereby cuniily �h;il I have read anA examined Ihis appli�;ation anA hnuw Ihe samo lo bo irue and correcl. All provisions of laws �nd <br />�rcJinaces yovernmp Ilils typo of work will be compGed wlih wh��lher spocilieA hrnain or noL The granting of a permit Joes not presume <br />�. t:� �wc aulhuiity to violatr. or cancal Uw pruvisiun ul any olhar state or local law rcyulaling conslruction or Ihe peAormance ol <br />��onstructiun Thal I am nuQionzed by Iho owner ol Ihi�, prop�rly to perlorm Iho worh lor which applicalion is made and I comply with lho <br />Sta�� (:ontra�,lors La�.v 1H.27 Hi.W aikl 2`16200 WAC. • <br />� : -_ �-s���- ".'t-�� J��?- �.�JS" � <br />� Si� n,il I O�vn onlraclor� uU�or � cn� ade � <br />