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�`RI�AIT APPLICATIt�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.ory <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />6.� i� . <br />LEGAL� � OT NO. i BLOCK <br />DESC.r <br />PARCEL TAX I.D. # <br />TRACT <br />i' iZ03 a�J?"U�I <br />PERMIT # <br />i-v <br />`��r��.nri ��.�v.�� � tilo�. 44b•A..+. �J� ��-+ ,J ws � -N7r/-5S �'S <br />TENANT NAME I CONIACT FOR PERMIT PHONE <br />. �,.,.,_ <br />CONTRACTOR ��e J�+^1 1!�>.u� ADDRESS <br />S O`+.c� <br />CONTR. LICENSE # <br />aJnNoJ H � »� w <br />USE OF BUILDING <br />5 ��'�. <br />WORK DESCRIPTION <br />; Fr`, rs�s zco,� <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Todet �/ <br />Bathtub /� <br />Lavatory (wash basin) U <br />Shower ! <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/barlmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Ftoof drains <br />Other <br />HEATSOURCE <br />Electric :�Gas Other <br />CITYIZIP PHONE <br />� <br />CONTRACT PRICE OF WORK <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 />Clathes dryer <br />Range hood <br />Exhaust fan ! i / <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this applicatlon and know the same to be true and cortect. AII provisions af laws and <br />ordinaces governing this type of work will he complied with whether specifted herein or not. The granting of a pertnit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulafing construction or the perfortnance of <br />construction. That I am authorized by the owner of ihis property to perform the work for which application is made and I wmply with the <br />State Contractors Law 18.2 C d 29fi.200 WAC. <br />��- �zSignature .�f Ow eNContractod onzed Agent Date <br />