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SI7c ADDRESS <br />a� an� <br />LEGA LOT NO. <br />DESC. <br />sn�o - a�7 <br />PERMIT APF�,IICATI�?N <br />CITY OF EVERETi P�RMf? �ERVICES <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 />BLOCK <br />�w�. �e D ��T <br />TENANiNAMt� 1,,^ <br />(�IQ1CN \N� UIJ�� <br />�i���c i �0�'"�J4�� ��J <br />CONTRACTOR �� � <br />f.ONTR. LICENSE # <br />USE OF BUILDING <br />PARCEL TAX I.D. # <br />t no5� :�a� � ��oo ��r� <br />iJ—TRAC7 <br />1 <br />ADDRESS CITY2IP <br />P.�o.�x �1� 33� dl4m, <br />I CONTACTFOP.PERMIT <br />3 I �e�rv� �Pa/ <br />CiJ <br />AODRESS CITYIZIP <br />HEATSOURCE I <br />�Electric _ Gas _ Olher <br />WORK DESCRIPTION , <br />Co(,��� a�n. E,x. �s��v�c� CP�. w�.�tnD�Jpie, � <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />La�alory (wash 6asin) <br />Shuwer <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drai�s <br />Other �v' � b�4 <br />PHONE <br />'al¢C�'�o�-`i�brb�5 <br />PHONE <br />CONTRACT PRICE OF WORK <br />� l$, pC�� <br />N0. I TYPE OF FIX7URE 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 />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woods!ove <br />_ Other A9�14 <br />CITY OF EVERETS' ! OCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined lhis application and know the same to be true and correcl All provisions of laws ard <br />ordinaces governing lhis type of work will be complied with whether specified herein or nol. The granting of a permit does not presume <br />lo give authority to violate or cancel ihe provision of any other state or local law regulatiny construction or the performance of <br />construction. That I am authorized by the owner of this property to pertorm the work (or which application is made and I comply with the <br />Sta;e Contractors Law 18.27 RCW and 296.200 WAC. <br />Signature o�wnerlConiractor/Authorized Agent Date 'l2 <br />