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SITE <br />TENANTNAME <br />N/A <br />PERMIT APPLICATION <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 TAIC I.D. • <br />LQ. <br />TRACT OH <br />COtITACT FOR PlRMR <br />MA�.y ��ae5 <br />bV1�IHNliWH <br />ahifct-! or l� um�vi� <br />CONTR. LICENSE 11 N IA <br />USE OF BUILDING � <br />N 1 � ILI� <br />Snol�om�sh �iun7� <br />HEATSOURCE <br />�C Electri��� Gas _ Other <br />PMONE /�K <br />�g20� 25$- ZSq <br />HONE qz$- a.58 -�� <br />E-MAILr,'R4fSC`�.��{'4fS/101t /JIL•C <br />_ �(as�so- �5��� <br />CONTRA PRICE OF WORK � <br />��. .P� (�'Iv�n 4 S CL� . <br />h•rC_ <br />WORK!D7EMSCRIPTION <br />'� Ke�DF:a7�A� iioMES �NS?Qal.G1 �o^� � C�— fN�'FC �E��Qoon\ '�— <br />�� � —_-_s� /�il.�l�. .3/� � / <br />NO. I TYPE OF FlXTURE OR I7EM <br />Toilet <br />BatMub <br />Lavatory (wash basin) <br />snower �5 - 8� e��� N�[� <br />Kitchen sink 8 disposal �CN NoME <br />Dishwasher <br />Clolhes washer <br />W3ler heater <br />Siok (service�bar/mop/etcJ <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drafn <br />Grease trap <br />Roof drains <br />Other <br />NO. <br />TYPE OF Fl%TURE OR ITEM <br />A/G — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas lireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustlan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODii IS 5105 <br />/ <br />I hereby ceritity fhat I have read and examined Ihis applicaUon and krww the same to'�e lrue and cortecL NI provislons ol laws and <br />ordinaces governing this type ot work will be complied with whether speclfied hereln o� not. The granNng ol a pertnit does not presume <br />to give authority to violate or cancel the provision ot any other state or local law regulaynp constructlon or the performance of <br />wnsiruction. That I am a�thonzed by the owner of ihis property to perfottn the work for which applicallon is made and I oomply with ihe <br />Stale Contractors Law 11J,27 RCW and 296.200 WAC. , / , <br />�� <br />