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PERMBT �►PPLICATIUN <br />CiTY OF EVERETT PERMIT SERVICES <br />3200 CEDAP. STREET, FVERETf, WA 98201 <br />425-?57-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACC�PTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE kOT ACCEPTED <br />SITEADURESS `LJ�iv���,'j$�C3 PARCELTA%I.D.I! ERMIT# / � <br />7��i �c.u�v�,v;��� wr,,,S.;�1iG� �80,5'0-700301.�00 � 7D�/'�l � <br />LOT <br />DESC. <br />TRACT <br />`J`�:�tn�r;d Case�di k��zR� L1.C'.,V��C.� a�ox 7�fo$.'��,;Zv. q�ni ,�,o,�x %�a%� <br />TENANT!JAME CONTACTFORPERMIT PH�NE <br />�Z.i�V,��vc1 �i�ti�iS v� ��ct`��SC✓� �`1J-S�3�i�1`504+-1 <br />CO4TRACTOR A�DRESS CfTY21P �I8��5 PHONE <br />F� yo�'`o N���v�, l-v�c. �1�tC� H���o�. P�. e�,s�,-c� a��, m,.k.�t�.o C�l')S�3h5 -So`t`t <br />coATR. L� :ENSE k A�-��-1'� � C� �I� OD <br />USt OF BUILDING <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />WORKDESCRIPTION-Z�`�tii� ��� �I��yy��ha�(r� <br />\C� 1 �C\L\ Cl�. .��VY�"�VG✓�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />l�aintub <br />Lavatory pvash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasnor <br />Clolhes washer <br />Laundry iray <br />Sink (service/bar/mop/elc.) <br />Backtlow preventer <br />Urinal <br />Drinking Fountain <br />Floor orain <br />Gre�se trap <br />Roo( dreins <br />Other <br />CONTRACT PRICE OF WORK <br />� I, �`�C� w <br />1�i.�SYi��t 1 �VS� NACI-•�`fLI <br />NO. <br />TYPE OF FI%TURE OR I �EM <br />A/C - air handling units <br />Forced 2ir systems <br />Gas pipin, <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhau=tfan <br />Heat pump <br />Unit heater <br />Boiler <br />Fiefrigeralion <br />Woodstove <br />Olher <br />CffY OF EVERETT LOCAL SALES TA% CODE IS 3705 <br />I herebvi cerilify that I have read and examined this application and know lhe same to be true and correct. All provisions of laws ard <br />ordinacas governing this type of work will be complied with whether specifed herein or not. The granting of a permit does not presume <br />to give authonty to violate or cancel the provision of any other state or local law regulating construction or the peAormance of <br />construction. That I am authorized by the owner of Ihis property to perform the work for which applicalion is mado and I comply with the <br />State Contractors Law 18.27 RCW and 296.e00 WAC. <br />� ��.,,.�.- �,�) �� �3� ° 7 <br />SignaWre of Owner ontrectodAuthor¢ed Ar it Date �I <br />� <br />