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PE:I�MIT APPLICAT{ON <br />CITY OF EVERETT PERMI i SERVICES <br />3200 CEDAR STRE[T EVERETT WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org /� `�� ��y <br />� <br />'.�'1 �,.iCA"fIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS r PARCEL TAX I.D. # P�E7R,.M,IT # <br />"llol�l G,1Lnn rroo�� �1V1/ _ �:i5r7� �h'"1 fN� �i0(1 f lili 1•7(J�{ �Q' �J( 5 <br />S�ll <br />DESC. <br />TRACT <br />� <br />TENANTNAME u CONTACTFORPERMIT <br />� a � • I��buL- � irl(, '�(c�i'1S�'21.0 � <br />CONTRACTOR ADDRESS' <br />l—�hr- ���,eao Czwhu c-ti�, Ll�. ? o, t� S � l�t <br />CONTR. LICENS[ # _ _ _ .-� _ <br />USE OF BUILDING <br />HEAT SOURCE <br />� Eledric _ Gas _ Olher <br />PHONE <br />�'� <br />PHONE <br />ci�,�ct�� (�� ��1�1r,� SS f J <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />�em,: :� rh-ti�Y, u.�a-f l5, bwlci �uu- t�ie�, �,Tti-tiu, 1��� �c C�;dv.�� �',�i.i- u1tA,� <br />�L�ti1_. -4ih,,�(:� i�:cu..sL� C0.^-(�F-�4�+ mi�ror I�,u�. rQ.i:��o�.�. �t:..-kr-iLaS?. u-(u.� bp�vV.f'CC„- <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry �ray <br />Sink (service/6arlmop/etc.) <br />BackOow preventer <br />Urinal <br />�rinking Foantain <br />Floor drain <br />Grea:e irap <br />Roof drains <br />Other <br />NO. I NPE OF FIXTURE OR ITEM <br />A/C — air hantlling units <br />Forced air syslems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhausl fan <br />Heal punp <br />Unil heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS �105 <br />I hereby ceritify that I have read and examined this appliczlion and know lhe sam= to be true and correct. All provisions o( laws and <br />ordinaces governing this iype of work will be complied wit!� whether specifed herein or noL The granting ot a permit does not presume <br />to give authoriry to violate or cancel the provision of any other state or local law regulating construction or the pedormance of <br />conslruclion. That I am aulhorized by �he owner of thir; property to pertorm the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Y�� <br />- �.�v,, �.,����,��,, �..�. <br />