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� �RMIT A�PLICATI�N <br />CITY uF 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 />SITE ADDRESS <br />830 $� EJc'�t�l� w� <br />LEGAL LOT NO. BLOC <br />OESC. <br />,�l,Orv c s� CC / <br />PARCEL TAX I.D. # <br />TRACT OR SU9Di'JISION # <br />�30 SE E�v�t��%ma/� <br />PERMIT # <br />�0�{o I _ o � 9 <br />�G <br />TENANT NAME I CONTACT FOR PERMIT PHONE Z� 6'�j SJ ' 7 7 7� <br />p(�,rv� �Qe+er kdlti I���. <br />E-MAIL <br />C NTRACTOR �� ,,,ccc�����,� ADDRESS CITYIZIP PHO E <br />CONTR. LICENSE p / S Sv 7- <br />USE OF BUILDING <br />�,�c� <br />WORK DESCRIPTION <br />P� a <br />HEATSOURCE <br />_ Electric _ Gas __ Other <br />CONTRACT PRICE OF WORK <br />p���y, o a v <br />5��� � -� ^� �� ( S�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />� <br />� <br />� <br />� <br />Toilet <br />BathWb <br />Lavalory (wash basin) <br />SLower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />NO. I TYPE Of FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Cblhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriliiy lhat I have read andlekamined this app�ication and know lhe same lo be true and correct. All provisions of laws and <br />ordinaces goveming Ihis rype of work will bo complied with whelher specilied herein or not. The grantinc� of a pormit does nol presume <br />lo give authority to viol 'le or cancel 1 io �i�ovisi n of any olher state or local law reyulating censlruclion or lhe per(ormance of <br />construclion. That` ar��Ulhori d�b the wn of lhis properly lo perform lhe work for which applicalion is made and I comply wilh lhe <br />Slale Conlraclors L�a 1$`�7 R W an 29 20 WAC. <br />j� � �)�. �- U/ �� <br />Signalure of OwnedCon�raclor/�ulhorized Agenl ale <br />\ ��2 <br />