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P�RMIT APPLICATI�I <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEU.4R STREET, EVCRETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CA;:1S ARE NOT ACCEPTED <br />SITE ADDRESS <br />�, � <br />f �/i�'. nb-C ...c l.tl�'., �o <br />LE3A LOT NO. BLOCK � TRACT <br />DESC. <br />PARCEL TAX I.D. # <br />#�% <br />Q4-00� <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />1 /F'«,�/i� C'�cPa IG� �L�ti f-�'� � `� 7/!✓ ����' .2�/C "FS'�_S-- <br />CONTRACTOR ��.d�,;�rl/(/n S� f/<•l,AD� SS P n, �� /7CITY2IP PHONE <br />vZ O� l' sC `� G- o`7�c�S <br />CONTR. LICENSE # P�� ��f'� (J ���1 j Y�'f f?�.� �� ` zf �i i. r/ 11,/ <br />USE OF BUILDING <br />WORK D'cSCRIPTIJN <br />�-'�. T:-- i, �; •fc /.��v C <br />/�/�� wG/^-A r <br />,i � � <br />G� � r� �!%� <br />/ -� n �t� c <br />NO. I 7YPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basirq <br />Shower <br />Kitchen sink S disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />Urinal <br />Dnnking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEAT SOURCE <br />Electric _ Gas _ Other <br />/U,k �� � ,,r��,, N <br />CONTRACT PRICE OF WORK <br />� � � ti� v� <br />� /'f" c, <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />�' Gas piping _ .� <br />_ water heater i �� <br />Gas fireplace � <br />u Gas range � � � <br />Clothes dr/er� <br />`� Range hood � yp � � <br />Exhaust fan _ ! <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />Olher � � <br />�_ r' a � /1 iv ���. <br />I /;,., r� o, t,'//,e /;,,� k� v <br />_,�—. <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3705 <br />I hereby ceritify that 1 have read and examined this application and know the same to be t; ue and correct. All provisions of laws and <br />ordinaces goveming this type of work will be complied with �.vhether specified herein or not. The granting of a permi: does not presume <br />!o give authonry to violate or cancel the provision of any other stale or local law regulating construction or the performance of <br />construction. That I am 3Lthorized by the owner of this property to perform tne work for which applicatior� is made and I comply with the <br />State Contractors Ld� 8.27 RGW and 296.200 WAC. <br />� <br />i <br />l%�i��' <br />