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FcRMIT APPLICAT�N <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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />Q�,1 �,,, Q,, ti. A ���ua�i�ir� t�n-� y� � rnou� �-osa. <br />L07N0. I BLOCK � TRACT <br />T/�Y�rY r / 1,�'QU'^„'N V �� ��-i�y /TT �T 1 7±pv/1 y�5-�2-Olc <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />� I 8(zYst�l ��FF Lf"1r-77S-G�l(o� <br />CONTRACTOR <br />DhY �-n� t � <br />CONTR. LICENSE N r� <br />USE OF BUILDING <br />O�umB„v6- d-tl�lr <br />�nJSAl� a�F� <br />ADORESS CIT1'RIP PHONE <br />Ka6l �F 13.t� M�- cd . LY�nI `1�37 �f 25-?�s--G'(G� <br />HEAT SOURCE <br />,� Electric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />� � �n�'J�o , UD <br />WORKD'cSCRIPTION �SrR�L ./E�1% C�-CC�7�l�- �� PNInQ {� /Tl2 �l'��"OL�L" <br />N <br />NO. I TYPE OF fIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposat <br />Dishwasher <br />Clothes washer <br />Laundry Vay <br />Sink (service/barlmop/etc.) <br />Back9ow preventer <br />Urinal <br />Drinkin� Fountain <br />Floor drain <br />Grease trep <br />Roof drains <br />Cther <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — afr handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />i Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />� Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodsiove <br />J_ Other ELECT/CIC fi'I� NA*�D�2 <br />CITY OF EVEREIT LOCAL SALES 7AX CODE IS 3105 <br />I hereby teritify that I have read anj examined this application and know the same to be true and ccrrect. All provisions of laws and <br />ordinaces governing lhis type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />�� give authority to violate or cancel the provision of any other state or lecal law regulating construction or the perfortnance of <br />struction. That I am authorized by the owner of this property to perform the work for which applicaGon is made and I comply with Ihe <br />.,.ate Contra�tors Law 18.27 RGW apd 7.96Zad WAC. � <br />