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PERMIT APPLICATION <br />CITY OF EVERFTT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />4 --�_o� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS �" �% �' D �✓C��C'✓t Pi�7 PARCEI. TAX I.D. # PE�iMIT � <br />131i1�i /-�� l 9b ��-�� ✓ 2 f� D4 /.3CD30Z 3cYs I�i�L�`� � <br />LOT NO. <br />TENANTNAME <br />BLOCK I TRACT <br />CONTRACTOR �[(7)a��K <br />CUi7�''fG�F; �Ji-� (/�5�� <br />CONTR LICENSE X , <br />USE OF BUILOING �� / G <br />CITYIZIP PMONE i7.7 t. A�� <br />re'�n u��/ Ev'��c ri•, w:'-� r�K� � <br />i�n ��� �,,,,_ /U �L <br />ADDRESS <br />753 /�, ��, ,r, <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />PHONE <br />�J L S (r 70 <br />CITYIZIP PHONE <br />Sc'l /��C, � L6,1,� � J7 L3 � <br />lai�t�vyz� 43z� <br />CONTRACT PRICE OF WORK <br />�07, ,5z � <br />WORKDESCRIPTION ��✓uni� l��l��✓I/Y-«'l��rff ' ��iL')0%!7Gh7 ��t�Y:�/"�/�h/� tc�l/� <br />I�C�G�'a- <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floar drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas f replace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Heat pump <br />Unit heater <br />Boiler <br />RefrigeraGon <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I herehy ceritify that I have read and examined this application and know lhe same to be true and corted. All provisions of laws and <br />ordinaces governing lhis lype o(work will be complied with whether specified herein or not. The granting of a pertnit does not presume <br />to give autnurity to vio�ate or cancei the provision of any other state or local law regulating constructicn orthe per(ormance of <br />wnstrudion. That I am authorized by the awner of this property to per(ortn the worh for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />1i2f � i ,}f�,• � %��:at� � ' l�J G`� <br />Signatur�o nedContraclorAuthonzed gent Date �r <br />L <br />