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PC.RMIT APPLI�ATIC J <br />CITY OF EVERETT PERMRT SERVICES <br />3200 t:EDAR STREET, EVERETT, WA 98201 <br />425-257-BE' 0 -� FAX 425-257-BB57 —www.evereriwe.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SffE ADDRESS ��� �IM�� � <br />11� <br />LEGAL LOTNO. �� BLOCN TRACT <br />DESC. <br />TENANTNAME <br />PARCEL TAX I.D. N <br />�i(/E <br />CONTACTFORPERMIT <br />I �r�'�21a <br />PHONE � ,�l� <br />PHONE <br />CONTRACTOR DDRE85 � CITY2IP PHON <br />d�Pmc� s�z.3"'-is� •��70 <br />CONTIi. 4CEn�e •[_Jl�DN��� `IS/� �� ii/�IDZ� �2���{/L/1,d' �f/A— <br />LSE <br />USE OF BUILDING � HEAT SOURCE I CONTRACT PRICE OF WORK <br />_ Eleclrit �es _ Other <br />WORK D SC` � RIPTION � � � <br />C J.6LJLC.� O <br />� �'� � � � <br />NU. � TYPE OF FIXTURE OR ITEM <br />�� Toile� <br />�Bathtub <br />Lavetory (wash basin) <br />� Shower <br />� Kitchen sink 8 disposal <br />__1__ Dishwesher <br />� Clothes wasfier <br />__ Laundrytrey <br />Sink (service/berlmop/etc ) <br />Beckflow preventer <br />� Unnol <br />� Dnnking i-ountein <br />Floor drain <br />Grease irep <br />Hool drains <br />Uther <br />NO. I TYPE OF FI%TURE OR ITEM <br />AIC — eir handling unils <br />L Forced elr sysfems <br />Ges piping <br />L Weter heeter <br />1 Gas fireplace <br />L Gasrenge <br />J_ Clothes dryer <br />_1. Renge hood <br />Ezheust len <br />__ Hea� pump <br />UNt heater <br />' Bollar <br />� ReMgeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE 19 �106 <br />I hereby centily lhet I heve read end esamined ihis epplication and know lhe seme to be true end correcl. !UI provfaiona ollews end <br />ordinaces govaming this type ol work wi�l be complled wilh vfielher apedfied hereln or not. The grenling o1 e permfl doea not pteaume <br />to give authonty to violete or cancel the provisian ol any otl� � stete or lucal law reguletlng consWction or the perfortnance of �th ihe <br />construdion. Thel I em euQianzed by ihe •wner ot this property to perform the work for which applicetion la mede end I comply <br />Slele Contractors Law 18.27 RCW and 286.200 WAC. <br />/. �."'i:; i <br />