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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.8verettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. it <br />SITE ADDRE4 0 <br />�v <br />' �' <br />LEGA LOT NO. BLOCK TRACT <br />DESC. <br />ADDRESS <br />OWNER (( i n� <br />SUn ��nc� Jan-Lrgyt'S1'�CIA + <br />TENANT NAME CONTACT FOR PERMIT <br />>t7.(, rip f1 �l u714 <br />PHONE <br />CiA3-) 3Iq <br />RE <br />CONTRACTOR Cjprjrj()I ,Q� �I ,�S CO ADFIC (7-ri <br />CONTR. LICENSE Kjt�SCvL-Q65LZ6 <br />USE OF BUILDING <br />j' <br />r <br />WORK DESCRIPTION <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 (servirelbarlmopletc.) <br />_ Backflow preventer <br />_ Urinal <br />_ Drinking Fountain <br />_ Floor drain <br />_ Grease trap <br />_ Roof drains <br />other�— <br />HEAT SOURCE <br />Electric _Gas_ Other <br />CITYIZIP PHONE a(� <br />/ 0' <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ AIC —air handling units <br />_ Forced air systeo s <br />Gas pipheaing <br />W aler ler <br />_ Gas fireplace <br />_ Gas range <br />_ Clothes dryer <br />_ Range hood <br />_ Exhaust tan <br />_ Heat pump <br />_ Unit healer <br />_ Boiler <br />_ Refrigeration <br />_ Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />to gordlnaces ive authority to 9ithis olal type <br />cancel work <br />will <br />beco <br />ionmplied <br />with <br />olhehethestatspecified <br />or aweregulaUngrein or tconstrucllon or. The granting olhe perfof a rrmance of presume <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. 1/3/06 <br />cO raclodAuthorited Agent Dat 11 7j <br />