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�RMIT APPLI�ATI�N <br />� CITY OF EVERETT PtRMiT SERVICE� <br />3200 CEDAR Sl'REET, 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 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />l�LEGAI� LOT NO. <br />I I ,. a°3 <br />BLOCK <br />VYYIYCR <br />�n� v 1��� <br />TENANTNA6IE �1e�l,Ju <br />�.�� �-�1 � �` _ <br />CONiRACTOR •�--� � <br />CONTR. LICENSE # <br />_ =iH f3 �TL *,� <br />USE OF BUILDING <br />���cc�:�� `�=�-o �� <br />WORK DESCRIPTION <br />(�,��,II �ep�ace <br />�l C�a��� <br />NO. I TYPE OF FIXTURE OR ITEM <br />PARCEL TAX I.D. # <br />TRACT <br />��� ��l�Q�- I� <br />CONTACT FOR PERMIT i � <br />ADDRESS <br />�1 en y ( j�-��� P <br />HEATSOURCE <br />_ Electric _ Gas <br />a s� r, qle_ cQ�� <br />c�ao� ��c���-�.�,ce <br />_ lailel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal �' <br />Dishwasher <br />Clothes washer . <br />_ Laundry tray <br />Sink (service/bar/mop/etc:) � <br />BackOow pr�venter <br />Urinal <br />Drinkiny Fountain <br />Floor drain � ���. <br />Grease trap <br />_ Roof drains <br />Olher <br /># <br />�� <br />_� <br />� PHONE <br />;�, o ��l�s � Y�� �8� a� <br />CITY!ZIP PHONE <br />� ��r�s)31�7-5'� I� <br />CONTRACT PRICE OF WORK <br />r �o� "`" <br />�,ce -�a� <br />MtGF1ANIGAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />G2s (ireplace <br />Gas range <br />Clolhes dryer <br />Rangc hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration -- <br />woodstove -., <br />Other �ro�_ �`� <br />— — ---- ---� <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined this applicalion and know lhe same to be true and correct. All provisions of laws and <br />ordinaces governing Ihis tyoe of wo-k will be complied wilh whether speci(ied herein or not. The granting of a permit does not presume <br />!o give aut ority lo violate or cancel lhe provision of any olher stale or local law regulating consWclion or the performance of <br />constructi n; That I am aulhorized by the ovmer of this property lo periorm the work for which application is made and I comply with the <br />State Cqt tr�dGrs Law 18.27 RCW and 296.200 WAC. <br />V� <br />'�2 <br />