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; PE.:MIT AF'PLICATIO�� <br />CITY OF EVERETT PERMIT SERVICES <br />I 3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257 8857 <br />— wvw✓.everettwa.org � <br />' % `-•) ��' C� � �_: <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SI7E ADDP.ESS PARCEL 7AX I.D. q PERMIJp <br />� � ,)�.,• �'; ., � ) > UC� �j ��'� C.�DOUO 1 100 � �(J, '���- �' ��-• <br />LEGAL LOTNO. - �LOCK TRACT <br />DESC. �� <br />,......_.. ,�e� tt �-�tr�?. .i f � 2D t- o� 5- oy <br />TENANTNAME <br />�- 101 � I �%c�er <br />ICONTACTFOR PERMIT <br />PHONE <br />y 78� <br />CONTRACTOR ADORESS � CITY2IP 7HJNE <br />/�r'�l•S0.rl Ho��,esL��. lolal E'_ce��r�r�, W� �.v�zrettq5�o�1 �CL�•Ll7£'•G�9�/7 <br />CONTR. LICENSE # <br />USE OF BUILDING <br />�c.�ir����a� <br />•• � • <br />HEATSOURCE <br />_ Electric � Gas _ Otner <br />��fr": ,� .)(,.1�� i���t'.� �J r:, � <br />NO. I TYPE UF FIXTURE OR ITEM <br />TOilet <br />Bathtub <br />� Lavatory (wash basin) <br />Shower <br />Ki:chen sink 8 disposal <br />Dishwasher <br />Clclhes washer <br />� Laundry tray <br />Sink (servicelbarimopietr.) <br />Backflow preventer <br />Urinal <br />Onnking Fnuntain <br />Floor drain <br />Grease trap <br />Rool Crains <br />Other <br />CONTRAC7 PRICE OF WOR" <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forcc-d air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaustfan <br />Heat pump <br />Umr heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other _ <br />CITY O� EVERETT LOCAL SALES TAX CODE IS J705 <br />I herety centify that I have read and examined this application and know tha sama to be tn.a and corroct. All provisions ol laws and <br />orninaces go: erning this rypq of work will be complied with whether specified herem or not. The grantlng of a permit does not presume <br />to give auUionr, ta violate or caicel the protiision of any other state or local law regulating construction or the performance of <br />canstruction. That I am authori;:etl by the owner of this property to perform the work for which app!ication is made and I comply with lhe <br />State Contractors Law 18.27 RCYI' and 29&.200 WAC. <br />S�;nawre of OwnevContrac;•,r,Authonzed Agent Date I� <br />