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�CRMIT APPLICATIC�IV <br />CITY OF EV�RETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-� 5�-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS , <br />�/ 2 ���; ,� -, <br />LEGAL LOTNO. / BLOCK <br />D°SC. <br />OWNER / <br />�J � �tl,iZ ��1��2i:,ti <br />TENANTNAME � <br />y4����� n. � , �.�u�.�.e,� <br />CONTRACTOR \ � <br />CONTR. LICENS�'#\ /��� �n� � ' <br />� � <br />USE OF BUI— LD— IN� <br />WORK DESCRIPTION <br />i ,�^ `�. <br />F' /� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Tailel <br />BalhWb <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drdin <br />Grease trap <br />Roof drains <br />Other <br />PARCEL TAX I.D. # <br />TRACT <br />ADDRE55 CITY2IP <br />/ <br />CONTACT FOR PERMIT <br />ADDRESS ��TY2�P <br />�Nz''w -19y��1�'f-�A�,�.S'a�J! <br />HEATSOURCE <br />_ ElecUic _ Gas _ Other <br />C � L: A � /I'1 <br />NO. <br />PERMIT # <br />'(Yl 0 5 <br />PHONE <br />PHONF�c�^py�,% ) �� <br />_l �.. o! ! l <br />-�„-� �Jas1�� �"�3� <br />CONTRACT PRICE OF WGRI( <br />MtGFiAN <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhausl fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrig�ration <br />Woodstove <br />Other <br />CITY OF EVEREIT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify lhal I have read and examined Ihis applicalion and know the same lo be We and correct. All provisions of laws and <br />ordinaces governinc� this rype of work will be complied wilh whelher specified herein or not The granting o( a permit does not presume <br />to give aulhority lo violale or cancel lhe provision of any olher state or local law regulating consWction or the performance of <br />construclion. l'hat I am aulhorized by lhe owner o( lhis property to pedorm the work for which application is made and I comply wilh lhe <br />State Contractors L�G+ 1827 RQW and 296.700 WAC. � � <br />