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�. wes�" c�Nsr, t31c�`r jf'�h,f <br />� <br />PERMIT APPLICATION <br />CITY OF EVERETT' PERMIT SERVICES <br />32C0 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 />SITE ADDRE55 <br />TRACT <br />DESC. <br />PARCEL TAX I.D. # <br />u�rvnerc •,••••,•��� <br />�i�il'�JS t �L'C'.�v�i� � �`V- . E,� <br />c }v <br />TENANT NAME CONTACT FOR PERMIT <br />S «,<•I �.�f<���E ,4�I�l���y � �n,.,�, �ro�,ar�i{" <br />P'"' <br />CONTRACTOR �1`���r M`���/�/L��(j�[, AD�RESS�'(pjQ /Si� <br />CONTR LICENSE # Mc �,. �r �� ��� 3 �-n� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />�/�s�°� � � f <br />Nt� �<<, ^� j <br />��'t� G��S. <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavarory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc. ) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEATSOURCE <br />Electric Gas Other <br />G; p{'< - f �, E' <br />� �11, 5,.��1,�•�i <br />NO. <br />O�DI -v�lZ1 <br />% <br />3 -ao-d <br />RMIT# _ <br />PHONE <br />�yzs�(�'2"32y� <br />CINy^2IP PHONE <br />I'�f16'�/L"�� �t�. <br />CONTRACT PRICE OF WORK <br />OJ'. � <br />�� /�/ ;S • <br />��9 S Ji ��/N� %c <br />b y o/l,e �s . <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Porced air syslems <br />Gas piping <br />Water heater <br />Gas freplace <br />Gasrange <br />Clolhes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />O:her <br />CIN OF FVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby ceritify thal I have read and examined this application and know the same ;o be true and correct. All provisions of laws and <br />ordinaces goveming this type o(�vork will 6e complied with whether specifed herein or not. The grenting of a permit does not presume <br />to give authoriry to violate or cancel the provision o( any olher slale or local law regulating construction or lhe performance of <br />construction. That I am authorized by lhe owner of this property to perform �he work for which applicalion is made and I comply wilh the <br />State Contradors Law 1827 RCW and 296.200 WAC. <br />Signature of OwnedContractodAuthonzed Agent Date <br />