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�rRMIT APPLICATI�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS ,�3 0 7 ,c r� �(dc I PARCEL TAX I.D. # I PERMIT i� /, <br />��o � <br />LOT NO. <br />BLOCK � TRACT OR SUBDIVISION # <br />,J�-f1� 2 �'cme.^ 1307 F4/�r�/ A'�� �v�/�Y.PI�/ ,ro37s7-///8 <br />TENANT NAME CONTACT FOR PERMIT PHONE�/� y�p � � L� <br />7 /6 <br />�l/c�,.� C���yfr��4��,/.:,, E-MAIL <br />tACTOR <br />w Go.c;;�,sfs �' w�,b�; r� <br />CONTR. LICENSE 11N� �� O P/" iJI C/ /�' <br />USE OF BUILDING <br />f'��y e <br />.....,� o� �oX ��� ) <br />NEAT SOURCE <br />_ Electric � Gas _ Other <br />%/ S'2�`1/�- ..3,�a�/ <br />CONTRACT PRICE OF WORK <br />��• � <br />WORK DESCRIPTION / / I�/ � / <br />�%�/./�` (( �H dC/n arl G' �✓%N" �['''�r' O/J G 4 f�i �6/c % rj�yc l�C <br />/'4,�i �l�a✓ y2J �i�c � fG�l� <br />NO. I TYPE OF FIXTURE OR �TEM <br />Toilet <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes wasr �r <br />Water heater <br />Sink (service/barlmop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. <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 />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />i hereby ceritiry that I have read and examined lhis application and know lhe same to be true and correct. All provisions of laws and <br />ordinaces governing lhis type o( work will !; � complied with whe�her specified herein or not. The granting of a pertnit does nol presume <br />to give authority to violale or cancel the p�uvision of any olher state or local law regulaliny conslructlon or the performance of <br />construction. That I am authorized by the owner of this property to peAorm the work for which applicalion is made and I comply wilh lhe <br />Slale Contraclors Law 18.27 RCW and 29 .200 WAC. <br />/�,� � 7/y/� � <br />