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P�r2MIT APPLICATIOi� <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 />4 �a�-os <br />APPLICATIOfJS ARE ACCEPTED FRGM 8 AM TO A PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT f1 <br />`�02 N.3�a�ouny Stc 3 2qp�1�o��.0���0 �1 � - � <br />LOT NO. I BLOCK I TRACT <br />DESC. <br />nl..�a PIIf�Q�i'C1�� �TD PM1T�(�54 5�,� j52.B 5"tZy�„vic� s�ABo�o <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />N� S-co�cQ�iLA � SarDUl1UE�� �T'E� C�RcEa 766 3S1-�5�j <br />CONTRt.CTOR ADDR SS CITY2IP PHONE <br />�JKv {-,��r�G��� ZIZS 1�16t`s�.sw �-iae �y.,,,.aLa�.,n 9i�36 <br />CONTR.LICENSE# � k � rA r-1 9�� D CI �� � ��_�J,—� ,y, <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR �TEM <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />LaunAry lray <br />Sink (service/bar/mop/elc.) <br />BackOow preventer <br />Urinal <br />Drinkinp Founlain <br />Floor drain <br />Greaso trap <br />Roof drains <br />Other <br />HEATSOURCE <br />Eleclric _ Gas _ Other <br />CONTRAC7 PRICE OF WORK <br />� J`—�� l� � <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handlin^ unils <br />Forced air syslenis <br />Gas piping <br />Water heater <br />Gas fireplacc <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeralion <br />Woodslove <br />CITV OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby cerili(y that I have read and examined this application and know the same lo be true and correcl. AII provisions of laws and <br />ordinaces goveming lhis rype o( work will be complied with whether specified herein or nol. The granting ot a permit does nol presume <br />to give aulhoriry to violate or cancel the provision of any olher stale or loca( law re�ulaling construction or the performance of <br />construction. That I am aulhorized by the owner of lhis propc�rty lo perform the work for which application is made and I comply with lhe <br />State Cqntractors Law 18.27 RCW and 296200 WAC. <br />✓�,.�i <br />/u/o5— <br />`/z <br />