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F+ :RMIT APPLICATI N <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 />SITE ADDRESS <br />LOTNO. <br />(�r�r�2 rv�c.2r; r <br />TENANTNAME <br />S: �ti� r <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />C�l.-' <br />I.VIVIKAI.IVR <br />Lcx�M�S ��NS� � �o� <br />CONTRLICENSE#LJV�IC J,'� <br />T' <br />USE OF BUILDING <br />or-r� cr SPa �r-_ <br />WOR.K DESCRIPTION <br />C � � / <br />� <br />� <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION p <br />060,� SSy <br />CONTACT FOR PERMIT <br />1-Cz�� y LooNi i S <br />�( �a-o --lc� <br />��P RMIT B <br />i��-�v <br />CITY2IP PHONE <br />yQ,20(o <br />E�r�n �rr �-IZS- z� 2 -ya s� <br />PHONE c��, -3tiv•s3s3 <br />E•MAIL L�MISCOIJSI �.aOL <br />tl`i2v �(cYf� Avr Snaat�uµ <br />%-�-1/ SE � 9B290 <br />HEATSOURCE <br />i <br />� Electric _ Gas _ <br />Other <br />yzs-3��y — <br />s3 s3 <br />CONTRACT PRICE OF WORK <br />ZO r O G'�'� <br />N r v C Aft pe ��%/� ��/-t' � G��3 �N � e TS, f�A2Tl o�v A[-1�C2r? f-i <br />Kri✓ �o�2i��(� , Z -,urw �s...�rrdt,a2 Do�2s' <br />ryq, I TYPE OF FIXTURE OR ITEM <br />� <br />� <br />� <br />n <br />Toilet <br />Bathtub <br />Lavatory (wasli basin) <br />Shower <br />Kilchen sink & disposal <br />Dlshwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />6ackflo�v preventcr <br />Urinal <br />Dri�king Fountain <br />Fleor drain <br />Grease trap <br />Roof drains <br />Other <br />N0. I TYPE OF FI%TURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />uas piping <br />Water heater <br />Gas frepiace <br />Gasrange <br />Clothes dryer <br />Ranye hood <br />Exhaust fan <br />_ Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woadstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� I hereby certify thal 1 have read and examined this application and kno�v the same lo be lrue and correct. All provisions of laws and <br />I <br />Iordinances governing Ihis type of work will be complied with whelher specifed herein or nol The granling ol a permit does not presume <br />lo give authority ro olale or cance� lhe provision of any other state or local law regulati�ig conslruction or the peAormance of <br />� construclion. That��n authorized by the owner of this property lo perform the work for which application is made and I comply with Ihe <br />Slate Conlractors b� 18,27 RCW and 29G200 WAC. � � <br />�_ _ <br />Signati <br />U <br />I�z <br />