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PERMIT �ePPLICATlO�I <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 ACCEPTED FROM 8 AM TO 4 PM <br /><' <br />LOT NO. � " BLOCK <br />h <br />TENANT <br />�✓<i.!%CJa�rJ G��•�'✓r ��✓L <br />CONTR. LICENSE # <br />C �%. ���/l�� <br />PARCEL TAX I.D. # <br />TRACT OR SUB��VISION # <br />CONTA`CT/ FOR PERMIT <br />Ij�O� /��r,�rr�� <br />�� - <br />�✓�� y�,� �y � �,� <br />PHONE ' f 2S- .3 3' �-�7 Oc <br />�Z�;rr.t'/G,ra� a ll0�2 , <br />ADDRt55 • a.�i uc r � ��..�... <br />�-: i-, 3'S'l l�.�' � i,� < x l ri` ���i - 33�' _ l7r�o <br />� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />�� .� ;.,v' `.,��1i <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />�ishwasher <br />Clothes washer <br />Waler healer <br />Sink (service/�admop!e1cJ <br />Backtlow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />�%Bc�J <br />� X/7. ✓Y /i � /� - <br />� HEATSOURCE I <br />Eleclric �Gas _ Olher <br />CONTRACT PRICE OF WORK <br />7i� af�P `n <br />� <br />SB�61 ��,r�v�� c5�ru� <br />j�/� � ��i.��— �T� <br />/./ljl'1`'' 7'L�/•'�- i� <br />�/:�:-�,�y�� <br />�r=�c^c f'Z�'iu7� <br />NO. I TYPE OF FIXTURE OR ITEM17 <br />NC - air handling unils <br />Forced air syslems <br />Gas piping <br />Waten c�o!er <br />Gas fi eplsce <br />Gas rs,�ye <br />Clothes dryer <br />Range hood <br />Exhaust(an <br />Neat pump <br />Unit heater <br />Boiler <br />Refriger2lion <br />Woodslove <br />CITY OF EVERETT LOCAL SAIES TAX CO�E IS 3105 <br />I hereby c2rili(y Oiat I have read and examined this applicalion and kno�v the same lo be true and wrrecl All provisions of laws and <br />ordinaces governing lhis lype of work will be complied with whe!her specified herein or noL The granting of a permil does not presume <br />lo give aulhority to violate or cancel lhe provision of any olher slate or local law regulating construciion or lhe performance o( <br />consiruction. That I am au horized by the owner of lhis property t�perform the work for �vhich application is made and I compiy wilh lhe <br />Stale Contr clors Law 18%27 RCW and 256.200 WAC. <br />�c�� 11,c � — � ? �� <br />�/L <br />