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PE�.tMIT �PPLICATIOt _ <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 —www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITEADDRESS3o� �Imon�e <br />LOT <br />OESC. <br />TENANT NAME <br />BLOCK I 7RACT <br />PARCEL TAX 1.0. N <br />�d/E <br />ICONTACT FOR PERN.IT PHONE <br />�r�f'"'� (/¢�,heJ �zS-7s�/ - <br />CONTRACTOR L. nm�� L(e „n�RE95 '� CITY2IP '/�'PH�ON�� <br />11�={i �..�_.yr� Y <br />CONTR. LICENlCc� /h 71U/_�1 /�.�d.LJ v ��� T���/ -/ ui�-C�ji1�« <br />USE OF BUILDINO <br />WORK D SC� RIPTION � <br />lL,. _. . ZD� <br />�[x6��c.e� <br />NO. I TYPE Of FIxTURE OR ITEM <br />,� Toilet <br />Bethtub <br />_ Lavatory (wesh basin) <br />� Shower <br />,� Kitchen sink 8 disposal <br />� Dishwesher <br />� Clothes wasfier <br />__ Laundry irey <br />Sink (servicelbadmop/etc.) <br />Beckflow preventer <br />V Urinel <br />^ prinking Fountain <br />Floor drain <br />Greasc irep <br />� Rooldreins <br />Other <br />�/4— <br />— HEAT SOURCE I CONTRACT PRICE OF WORK <br />Electric ✓ Ges Other <br />� ,�.� U.7 � <br />NO. � TYPE OF FI%TURE OR ITEM <br />A/C - air handling units <br />Forced elr syslems <br />Ges piping <br />Water heatar <br />1 Ges Areplace <br />� Gas renge <br />1 �lothes dryer <br />� Renge hood <br />Exhaustfan <br />_ Heetpump <br />Unit heater <br />'� Boiler <br />� Refrigeralion <br />Woadslove <br />Other <br />CITY OF EVERETT LOCAL SALE8 TAX CODE IS �106 <br />I hereby cerilify thet I heve read and exemined this epplicelion end know lhe seme to be true and coRecl. All provislons o1 lews and <br />ordinaces goveming this type ol work vnll be complied wilh whether epedfied hereln ot not. The grenting of e permll doea not presume <br />to give authority to violate or cancel the provision of eny other slete or loral law regulaGng canslruction or the performence of <br />construdion. That ; am euthorized by the owner of Ihis property lo peAorm lhe work (or which applicetion Is made end I comply with the <br />Stete Conirectors Lew 18.27 RCW end 288.200 WAC. <br />,' i y <br />. � . �.'l- � ' � <br />