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SITE ADDRESS <br />91 J3c�c <br />LEGAL LOT NO. <br />DESC. � S( <br />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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />a05y��0000i4�oo <br />BLOCK TRACT <br />7os1�...� 4-1..1� A�.� <br />— v c� <br />,(-1�,��-...,. J.�� P.�o. -r �5� ��" n4 µ�k I{��r9dz7s C'Izs) z34-Y�iz <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />�ut�.�� <br />CONTRACTOP <br />CONTR. LICENSE p <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilel <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Cblhes washer <br />� Water heater <br />Sink (service/bar/mop/etcJ <br />Backflow prevenler <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Olher <br />ADDRESS <br />HEATSOURCE <br />Electric Gas Olher <br />L� zs) • 23y-4`►L� <br />CITYIZIP PHONE <br />I CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Cblhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby ceritify lhat I have read and examined this application and know the same lo he true and wrrecL Ail provisions o( laws and <br />ordinaces governing Ihis lype of work will be complied wilh whelher spocified herein or not. The granling o( a pormit does nol presume <br />lo give 2uthorily to violale or cancel the provision of any other state or local law regulaling conslruclion or lhe performance of <br />ccnstruction. That I am authorized by the owner of this property to perform the work for which application is made and I compty wilh the <br />Slate Conlraclors Law 18.27 RCW and 296.200 W�C. <br />Signature of OwnedConiractor/Aulhonzed Agont Date <br />