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� <br />P�RMIT APPLICATI(��J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR Sl'REET, EVERETT, WA 98201 <br />425-25?-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />�a <br />LEGAL LOT N0. LOCK <br />DESC. <br />OWNER <br />TENANTNAME <br />� ' I TOR"�' e� � � � 1� 't'�5.�_ . 1 (1 � <br />_ _�— <br />CONTR. UCENSE # <br />, NPI �o��M ��-. <br />USE OF BUILDING � <br />WORK DESCRIPTION � n�}(,ttl i <br />�treCG{ica,�c�l S,ri ^5 . -R <br />PARCEL TAX I.D. # <br />TRACT OR SUBUIVISION # <br />ADDRESS <br />CONTACT FOR PERMIT <br />L(�� '� �P ��i l t Y <br />ADDRESS <br />�ia �'. gQ�o.r��.J e <br />HEATSOURCE <br />Il�3o-t� <br />PERMIT # <br />CrniSQ./l7, <br />PHONE 31n0-1r�1' �3�1� <br />�E-MAILiar��l TNe'S�yr�a� <br />C TYIZIP PHONE <br />��//� <br />�e�t•�ham 9&�r 3(�G9/•/3 <br />I CONTRACT PRICE OF WORK <br />_ Eleclric _ Gas _ Olher <br />i llu �ri (.J�-u S�ryV� G� /S(�l�y$ <br />� �%GY� • UG <br />/1pY1-111� M . <br />-��+re� a�_�< rno✓��c� �r�/or� s��i� av ,�-�ee� � �,�„ <br />Np, I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Glher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby coritify Ilial I have read and examined this application and know lhe same to be lrue and correct. All provisio!.s of laws and <br />ordinaces goveming Q?is rype of work will be complied wilh whether specified herein or not. The granting of a permit does nol presume <br />to give aulhoriry lo violate or cancel lhe provision of any other slale or local law regulating conslruction or the performance of <br />cons c�clion. Thal I am aulhorized by the owner of this properly to periorm the work for which appiication is made and I comply with the <br />�iai�Cnnt�ar.tors 12w 18.27 RCW and 2�6.200 WAC. . <br />