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PtRMIT 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.org <br />l,PPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />�anc� �T �,�r���� <br />DESC.� c�) <br />PARCEL TAX I.D. # <br />TR�ORSUBDIV�Sj10� ��� �� <br />�� ��� "�� � <br />PERMIT # <br />�A SN�dX� �DD/ �-�/ ��'r..'� %lZ03 <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />E-MAIL <br />CONTRACTO . ADDRESS TYIZIP HO E <br />�� �—o /"% <br />CONTR. LICENSE # <br />USE OF BUILDING <br />�� <br />WORK DESCRIPTION <br />�� `c� U "y7� j.C-- <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />W afer hea;er <br />Sink (servicelbar/mop/etc.) <br />Back(low prevenler <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEAT SOURCE <br />Eleclric _ Gas <br />I CONTRACT PRICE OF WORK <br />Other �SD�D• "�2���� <br />2`tXZ� — �v24 <br />Np. I TYPE OF FIXTURE OR ITEM <br />A/C — air handlinc� units <br />Forced air systems <br />Gas piping <br />W ater heater <br />Gas firepiace <br />Gas ranc�e <br />Clolhes drycr <br />Range hood <br />Exhausl (an <br />Heal pump <br />Unit heater <br />Boiler <br />Refri�eralion <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined this application and kno�v the same lo be true and correct. All provisions of laws and <br />ordinaces governing this lype of work will be complied with whelher specilied herein or not. The granting of a permil does nol presume <br />to give aulhority to violate or cancel the provision of any ulher slale or local law regulaling conshaction or the performance of <br />conslruction. That I am aulhorized by lhe owner of this propeAy to peAorm lhe work for �ich application is made and I comply with the <br />Stale Contraclors Law 18.27 R W and 296.200 WAC. ; Cj' <br />i �' /„= :1-� i �`' / <br />� � -' -:i2Z%" �'�/w�/ � " �7 %- —1 <br />Si9nalu e of OwnedConlractor Autlionzed \/ t Dale I <br />1 l <br />