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FRMIT APPLICATION <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 AA TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />1720 �S �'t SCd _ I (.')110-0gi <br />LOT NO. I BLOCK I TRACT <br />cyiG p�G / 720 _-7s''�`SW �yEl2�7T, 9�zo3 <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />�leoli COlt_rorz&t/ D Aj <br />CONTRACTOR D UjN ,� gam, <br />CONTR. LICENSE # <br />USE OF BUILDING <br />GrFI cpz <br />WORK DES9RIPTION OF /cE <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ Toilet <br />_ Bathtub <br />_ Lavatory (wash basin) <br />_ Shower <br />_ Kitchen sink 8 disposal <br />_ Dishwasher <br />_ Clothes washer <br />_ Laundry tray <br />_ Sink (service/barlmopletc.) <br />_ Backflow preventer <br />_ Unnal <br />_ Drinking Fountain <br />_ Floordrain <br />_ Grease trap <br />_ Roof drains <br />Other <br />ADDRESS CITY2IP <br />HEATSCURCE <br />_ Electric Gas _ Other <br />PHONE <br />CONTRACT PRICE OF WORK <br />�5U pop+ _ <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <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 />Wocdstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3100 <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. The granting of a permit does 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 a uth�anyy-�ed by the owner of this property to perform the work for which application is made and I comply with the <br />State Co . yaw 18,TyRCW and 296.200 WAC. <br />-Z9 -o¢- <br />I, <br />