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PcRMIT APPLICATRA <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, VITA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM N AM TO 4 PM <br />SITE ADDRESS t I 1 T I PARCEL TAX I.D. # Nt /rcymyr/i�\r` (/��/l <br />A_ - \� `\_A k J V V <br />LOT NO. <br />DESC. <br />TRACT OR SUBDIVISION # <br />-��C,a"- r tc ?-ion La�TA ri, c,JA �Fc2a f <br />TENANT NAME CONTACT FOR PERMIT PhON�r!�A l'by�_ CS-�S <br />�Awv)-:: I ��\Q1��-i� �E-MAILo �9S�i.�WCI. <br />Hirt <br />V V,\,l�nV 1 v,♦ �/� <br />Y ' I *A)f��c`C'N� <br />CONTR. LICENSE # <br />l�Ntdrne�c��431�9 <br />USE OF BUILDING <br />((Lott y9fNpc LAD VAKrr-fZ• 9 <br />HEATSOURCE <br />Electric _' Gas _- Other <br />WORK DESCRIPTION 1 IAS-eNLAe,/ <br />NO. I TYPE OF FIXTURE OR ITEM. <br />Toilet <br />_ Bathtub <br />_ Lavatory (wash basin) <br />_ Shower <br />_ Kitchen sink & disposal <br />_ Dishwasher <br />_ Clothes washer <br />Water heater <br />Sink (servicelbarlmop/etc.) <br />Backfiow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />_ Roof drains <br />Other <br />�-1; )3(v`1-99/0 <br />CONTRACT PRICE OF WORK <br />Zc- \L <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ A/C - air handling units <br />_Forced air systems <br />_ Gas piping <br />_ Water healer <br />_ Gas fireplace <br />_ Gas range <br />_ Clothes dryer <br />_ Range hood <br />_ Exhaust fan <br />Heat pump <br />_ Unit heater <br />_ Boiler <br />_ Refrigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provision: of laws and <br />ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit jo--s not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. T at I am authorized by the o ter of this property to perform the work for which application is made and I comply with the <br />State Contract rs a 1 27 W and 296. D WAC. <br />�fi r, 3.- I I- /D <br />