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i <br />PE�,MIT APPLICATIOh <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everetriva.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />'��� <br />LEGAL LOT N0. <br />BLOCK <br />P�.R EL TAX I.D. # <br />?Yos� �c�✓3o'l000 <br />TRACT <br />TENANT NAME � CONTACT FOR PERMIT ' � PHONE <br />lv - <br />�%f�"'TDN G`�j� CLtnN �oml � JG�e��/ ,DALZIi�L �a-5-7��F-f38�1 <br />CONTRACTOR � ADDRC-55 CITY2IP PHONE <br />(JLy/Y1�IlC f�1P�i�ANlG4[- a-171� LGyr�/i�E...' W r�v�� l-(Ut�Cf�YlT�1LFi'�Gi.y �-/25"?J�l-��'�ll <br />CONTR. LICENSE x L✓A• ����43 <br />USE OF BUILDING � HEAT SOURCE I CONTRACT PRICE OF WORK <br />(�FFIGLY <br />12�= Alc.. <br />_ Electric �I Gas _ Other <br />O "� <br />WORKDESCRIPTION �jvS�ALL G �U�PLc �j�lJS W,f. CLG�N �OoiJ,� TNS/•qLG <br />S�/�'��'a'�O l2c'lutNAll' /J4CGlGv'��U.� CC�Yl2d�m <br />NO. <br />fll�[e] <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Disbwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Fioor drain <br />Grease trap <br />Roof drains <br />Other <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />W ater heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heatpump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woadstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3'105 <br />I hereby cer�tify that I hae�e read and examined lhis applicalion and know the same to be true and correct. All provisions of laws and <br />ordinaces go�eming this type of work •,vill be complied wilh whether specified herein or not. The granting or a permit does not presume <br />to give authonty to violate or cancel the provision of any other state or local law regulating construction or the perormance of <br />constructi n. That I am authorized by the owner of this property to perform the work for which application is made and I comply wdh the <br />State nt,.ctors Law 18.27 RCW and 296.200 WAC. <br />� � v I S� � <br />Signa e of 0 nen ontra r%Authorized Agent � Date � I I <br />