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F�RMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 � <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />n(/� S�, - l <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEDIT 6 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />�,� l) <br />LEGA LOT � <br />BLOCK I TRACT <br />PARCEL TAX I.D. # <br />UU <br />�E�b� ��f <br />�.1 <br />�n1��i �GrISI �J gU� ,�U7�1 �- )i�i�r-1�d�, Wl� � laa3 <br />TENANT NAME COkTACT FOR PERMIT PHONE <br />- _ I ._I ���� (l�cc � `k� r 75�f - ��3� <br />CONTRACTOR ����r� � �(/r�s'I <br />CONTR. LICENSE � L-I NO J�-..L �i) '�'l� v� <br />USE OF BUILDING <br />Si� I� <br />WORK DESCRIPTION <br />fi�l� ��� <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />BalhWb <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher_ _ <br />ADDRESS <br />� �� 3(J ��,� <br />CI'fY21P <br />S�U�N�, UJa <br />I`HONE <br />aa:� <br />HEAT S RCE I CON7RAC7 PRICE OF WORK <br />_ Electric Gas _ Olher � I j J,� ��)� � <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — air handlinc� units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas ranc�e <br />Clothes dryei <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Bailer <br />Refrigeration <br />Woodstove <br />Other <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby ceritify that I have read and examined this applicalion and know the sama to be lrue and correct All provisions of laws and <br />ordinaces governing lhis lype o( work will be complied with whether specified horein or not. The granting o( a permit does not presume <br />to give authority to violato or cancel Ihe provision of any other state or local law regulatin� consWction or lhe peAormance of <br />conslruction. That I am authorized by the owner of ihis property lo peAorm lhe work for which applicalion is made and I comply wilh the <br />Slale Conlrac�'ys Law 18.27 RCW and'196.200 WAC. <br />_� <br />