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� P�r�IVIIT APPLICATIG�J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETi, WA 98201 <br />425-2�7-8810 — FAX 425-257-8857 — www.everettwa.org � <br />F��� ����- � � <br />APPLICATIONS ARE ACCEPTE� FROM 8 Ah! TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEFTED <br />SITE ADDRESS <br />., , <br />,I: 1� <br />_EGAL LO7 NO. <br />BLOCK � TRAC; <br />PARCEL TAX I.D. # PERMIT M <br />C�U s� `�� J_L�ODUD I 1 a0 �( � C7�0� ci; " <br />D i�� <br />sr � 2 o�Z- w-s�'- i� <br />� __ o.v�,, <br />,�_��» i-io�ti�nS 5�,� )OI:�I �',��czrr.r ���( �, F�rrP•t1 94a v y�s. <br />I TENANTNAME I CONTACTFOR PERMIT' PHONE <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />•qrElSClrl iiO�r�eS LtC. IOIa I��r.rc���C�, c�,� 4 ���x��f qs�nv �C(� •`l7S'• (v9�/7 <br />CONTR. LICENSE t1 <br />USE OF BUILDING <br />-� i:��. .-- F/-�h�'L'�, <br />HEAT SOURCr <br />_ Electnc � Gas _ Other <br />WORK DESCRIP.TION �' ��:.�, J �• 1` I i.' i. ;..!,- YI l. i; <br />NO. � TYPE OF FIX7URE OR ITEM <br />_I Toilet <br />_ Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry Iray <br />Sink (service.�badmop/etc.) <br />Backflow preventer <br />Urinal <br />DrinYing Fountain <br />Floor orain <br />Grease trep <br />Roof drains <br />Cther <br />CONTRACT PRICE OF WORK <br />N0. � TYPE OF FIXTURE OR ITEM <br />T A/G — air handling units <br />Forced air systems <br />Gas piping <br />W ater heater <br />Gas `'replace <br />Gas range <br />Clathi+s dryer <br />� Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Bouer <br />Refrigeration <br />Waodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />i hereby ceritify that I have read ana examined this apolication and know the same to be true and conect. All provisions of laws and <br />orcinaces governing this rype of work wilt 6e complied with whether specified herein or not. The granting o( a permit does not presume <br />m gi:e authonty to violate or cancel tne provisien of any other state or local law regulating construction or the peAormance of <br />coostrucnon. 7hat I am authorized by the owner o( this property to pedorm the work for which application is made and I comply with the <br />State Conlrac;ois Law 18.27 RCW and 296.200 VJAC. <br />S�gnat�re of CwnenContracrouAuthonzed A�ert Date �Z <br />