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SIT[ ADDRESS <br />f �+' oT_ �ti�K f, <br />Lf:GAL LOT NO. <br />TENANTNAME <br />PEkMIT APPLICATIOtv <br />CITY OF EVERETT PERMIT SER'dICES <br />3200 CEDAR S?REET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8851- www.everettwa.org <br />APPLICA'fIONS ARE ACCEPTED FP.OM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />� � "s".5 <br />BLGCK � TRACT <br />3+x 25��-s' _ <br />CONT�CT FOR PERMIT <br />F�d <� <br />PERMII' �i <br />r�,.� ir- <br />GIIY/LIY rn�ne Z�`'.. <br />'� , W� t�plG_S' 3 ct �a z5. <br />PI10NE <br />�CONTRACTOR ��Ln•� �C�4��G�.L A�ORESS CIN/ZIP PHONE ,�r�^ <br />9�0�0 /s�,�='°,4tilnCE ,�i.rmo►+�Gi•j- �' $f13- <br />i3ONTR. LICENSE #� t�� r��// IG,� 'p'�OS'Z 92� S� <br />�� 70 ✓ <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash hasin) <br />Shower <br />Kitchen sinY, & diaposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />Sink fservice/badmop/etc.) <br />Backtluw preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />_ Eleclric _ Gas _ Olher I �,30�. DO <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handliny units <br />Forced air syslems <br />Gas piping <br />W ater heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />_L Exhaust fan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />CITY OF E<'C'��.TT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y lhal I have read and examined this appiication and know lhe same lo be true and correcL All provisions of laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or not. The granting of a permil does nol presume <br />to give aulhority to violale or cancel the provision of any o:her state or local la�v regulaling construction or the periormance of <br />conslruction. That I am aulhorized by lhe owner of this property to perform the �vork for which application is made and I comply with the <br />State Contraclors Law 18.27 RCW and 296.200 WAC. <br />� - ��' /� « �� nr_ <br />