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P�RMIT APPLICATI(,,�� <br />CITY OF EVERETT PERMlT SFRVICES <br />3200 CEDAR ST�tEET, EVtRETT, WA 98201 <br />425-257-8810 — FAX ?25-257-8857 — www.everettwaerg <br />APPLICATIONS ARE <br />SITEADDRESS <-���� � 4'J"�� <br />s�� � ��L� �,�oc�,��y <� <br />L'cGAL LOTNO. BLOCK <br />G��G�VG <br />TENANTNAME <br />CN ccn/G� <br />CONTRACTOR <br />FROM 8 AM TO 4 F11 - DEBIT & CREDIT CAi2DS ARE NOT ACCEPTED <br />PARCEL TAX I.D. # <br />Q�'—�'2/O /? D l �OU <br />TRACT <br />c� <br /># <br />L � '-� n 3 v /��y-�.f�� . �aa�`", <br />CONTACT FOR FcRM1T PHONE <br />LL � ��..v�`cC Le,� �oC-.P�7-�od�/ <br />ADDRESS CITY2IP PHONF. <br />�L��Q/ir� <br />CONTF2. LICENSE # <br />USE OF BUILDING <br />��: c�C� �: y.i D�=L I <br />HEATSOURCE <br />_ Electric <br />WORK DESCRIP710N <br />�t ) )��� �°�(- <br />�� ��� G� /� � f r . /lr/Ji[.!(.�4hlZ.1L � <br />NO. I TYPE CF FIXTURE OR ITEM <br />Toilet <br />Ba�htub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etcJ <br />Back�lew preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />I CONTRACT PRICt OF WORK <br />Other � � �� G7iC�. �y <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas pipir.g <br />Water heater <br />_ Gas fireplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaustfan <br />_ Heat pump <br />Unit heater <br />Boiler <br />Refrigeraticn <br />Woodstove <br />Other <br />CIN OF EVERETf LOCAL SALES TAX CO�E IS 5105 <br />I hereby ceritify fhat I have re2d and examined tnis application and know the same m be ln�e and correct All provisions of laws and <br />ordinaces governing ihis type of work will be complied with whether specified herein or noL The granting o( a permit does not presume <br />to give authonty to violate or cancel the provision of any olher state or local law regulating constrac.ion or the per(ormance of <br />consWction. That I am aufhorized by the owner o( this property to perform ihe work for which a�p!ication is made and I comply with the <br />Slate Contrectors Law 18.27 RCW and 296.2C0 WAC. <br />� --" -''- --. -,�------ �f-�/d'%D��. <br />—�." — <br />Siqnature of Owner/Conlract /Authonzed Agent: Date � <br />��L <br />