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P�r2MIT APPLICA�IOi� <br />CITY aF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />857 erettwa or <br />� 425-257-8810 — FAX 425-257-8 — www.ev . g �� � <br />� Q o z �� re�- rn s,i ,��o.k, 3�is 3 <br />APPLICATIONS ARE ACCEPTED FP'�M 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED — <br />SITE ADDRESS <br />LOT N0. <br />TENAN�NAME <br />BLOCK <br />('�rov-�n F�►"-� �!'O►�CG�IOn <br />CONTR. LICENSE # <br />USE OF BUILDING <br />Vt'ORK DESCRIPTION <br />/��i. CSg7� �pr�n�l�r <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/badmopietc.) <br />Back(low preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />� <br />PARCEL TAX I.D. # <br />TRACT <br />CONTACT FOR PERM(T <br />� ADDRE:aS <br />�j I3ox �Zil3 <br />J'7'!/// ���,�� <br />CITYIZIP <br />�-tii 9�DgZ <br />� <br />I — HEATSOURCE <br />Electric _ Gas Other <br />/ !Cl/�S <br />M <br />PERMIT# ;�""'' <br />�� <br />;130�-007 <br />PHONE <br />PHONE <br />��S �/�l � 71��9' <br />PHONE <br />�125 �fSl�7f��JfP <br />f f i C a�G('il�n f�` <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refric�eration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 9105 <br />I hereby cerilify that I have read and examined this application and know lhe same to be lrue and correct. All provisions of laws and <br />ordinaces governing lhis type o( work will be complied wilh whether specified herein or not. The granling of a permit does not presume <br />to give authority to violate or cancel lhe provision of any olher state or local law regulating construclion or the performance of <br />construclion. That I am authorized by lhe owner of this property to perform the work for which application is made and I comply with the <br />Slate ontreclors Law 18. CW and 296.200 WAC. <br />�'� %�Z$'/� _ i�Z <br />^ __ .._- -. .....,..�.-,. �...,.�,., n�� ,...�-,o,� n„o„� Date <br />