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FlcRMIT APPLICATIZuN <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 />G—i3�oy <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />a 2 • ,�i <br />LEGA LOT NO. <br />TENANTNAME <br />;3 �o,o D �NQ7 <br />BLOCK <br />PARCEL TAX I.D. # <br />2� _i�j- io <br />TRACT <br />CONTACT FGR PERMIT <br />� 3 <br />CONTRACTOk �� � � / � ( G � ADDRESS ^ L� .2SIP <br />. h(i'i � � Q '.. � � <br />CONTR.LICENSEp S q R �� S�' /���T j��; <br />USE OF BUILDING I HEAT SOURCE <br />,i. <br />WORK <br />NO. I TYPE OF FIXTURC- OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Dackflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />E�ectric _ Gas _ Olher <br />NO. <br />0' <br />PERMIT # <br />5 u 5u �: -c:� � <br />PHONE <br />CP�H}ONE <br />7 �e, d) <br />7�?3-2.�78 <br />CONTRACT PRICE OF WORK <br />MtGt1ANIGAL <br />NPE 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 />Clothes dryer <br />Ranc�e hood <br />Exhaustfan <br />Heal pump <br />Unil heater <br />Boiler <br />Re(rigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby ceritify thal i have read and examined this application and know the same to be lrue and correc.t. All provisions of laws and <br />ordinaces goveming this lype of work will bo complied with whether specified herein or not. The granling of a permit does not presume <br />to give authonty to violale or cancel the provision o( any olher state or local law regulatinc� consWclion or Ihe performance of <br />conslruction. That I am authorized by Uie owner of this property to pedortn the work for which application is made and I comply with lhe <br />Stale CoNractors La�v 1827 RCW and 296.200 WAC. <br />Signature ot OwnedContracror/Aulhonzed Agent Dato <br />�Z <br />