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FcRMIT APPLICATIuN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT', WA 98201 <br />425-257-8810 - FAX 425-257-8857 - wv-w.everettwa.org <br />�'� �oS-)3 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.�. # <br />PERMIT # <br />L�,v�s� �����s� G�� gox 3U7'i� SPa���, l�� �qaa3 <br />TENANTNAME I Co�r1 J/,ILC(SIT L��S l�-aa3� <br />N� ���/Y. <br />CONTRACTOR ! .„���C,/ <br />lJiv I7 <br />CONTR. LICENSE # L-iNn SGl- C�L`�I <br />USE OF BUILDING <br />WORK DESCRIPTION <br />,I_ ,' <br />NO. I TYPE OF FI%TURE OR ITEM <br />�� Toilet <br />�Bathlub <br />Lavatory (wash basin) <br />� Sho�ver <br />� Kitchen sink 8 disposal <br />� Dishwasher <br />� Clothes washer <br />_ Laundry lray <br />_ Sink (servicelb3r/mop/e;c.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />ADDRESS <br />N�� �a�( 3u7 ��- <br />CITY2IP PNONE <br />�Po,��� v�� >>a�.3 <br />— HEAT SQURCE I CONTRACT PRICE OF WORK <br />/ <br />Electric � Gas Other � 7��) j)( ) <br />/ <br />% <br />� <br />�/r — � _ <br />� ` _, <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handlinq unils <br />Forced air systems <br />Gas pipin� <br />Waler heatar <br />Gas fireplaco <br />Gas rango <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Healpump <br />Unit heater <br />Boiler <br />Relrigeralion <br />Woodstove <br />Other <br />CI fY OF EVERETT LOCf.L SALES TA7C CODE IS 3105 <br />I hereby ceritity lhat I have read and examined this application and know the same lo be lrue and wrtect. All provisions of laws and <br />ordinaces governing lhis type of work will be complied wilh whelher specified herein or nol. The granting of a permil does nol prosume <br />to give authority to violate or cancel the provision of any other stale or local law regulaling construclion or lhe performance of <br />conslruction. That I am aulhorized by the owner o( lhis property to perform the work tor which application is made and I comply wilh Iho <br />State ConlraCtqrs Law 18.27 RCW and 296.200 WAC. <br />