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PEFtMIT APPLICA.TION <br />CITY OF EVERETT PEF',MIT' SERVICES <br />3200 CEDAR STREET, EVEkcr, , 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 <br />3 � 31 �C ��a�rt� �v� <br />LOT,r�O. BLOCK <br />Iti �i l� 7�S <br />C6-ft/R� Lftli�L 333/ <br />PARCEL TAX I.D. # <br />Cb�37f- 7�5-��-A� <br />�ar,�r�esrr, ��v�s�aK `N � <br />��va�K/�� �, <br />PERMIT N <br />�—�ol—o� <br />- �- Zo90 <br />TENANTNAME CONTACTFORPERMIT PHONE <br />N• A• CGYDrt li/�G�ln�v �+G- S-zG- 09 r3 <br />CONTRACTOR PS TCM R��N� AooRess /,+� r(fO%�PS/N CITY2IP PHONE <br />rxil�� �EviR,�7ru�A• 9�?03 .f2S-f/8- 9G'f8 <br />CONTR. LICENSE #� `g ��R� 9 g 74 � J�'� g��/VTQ� _ <br />V <br />USE OF BUILDING <br />s���� ��m��y x�D,��� <br />HEATSOURCE <br />_ Electric � Gas _ Other <br />CONTRACT PRICE OF WORK <br />Q0� B/0 <br />WORK DESCRIPTION �/�( f,/}(,� /� ${}Tlr �lA4�fj �EDRdN%q , lif� R�/ t//76, ri',r�� <br />/N �E,��S� 6�/�l�T e/� g7! S: f <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />Sink (service/barimop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />� <br />TYPE OF FI)(TURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify thaf I have read and examined this application and know the same to be true and corcect. All provisions of laws and <br />ordinaces governing lhis type of work will be complied wilh whether specified herein or not. The granting o( a permit does not presume <br />to give aulhority to violate or cancel lhe provision of any other stale or local law regulatlng construcdon or the perfortnance of <br />construction. Th2t I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />�/Z <br />