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P�`RMIT APPLICATIt,,�� <br />CITY OF EVER�TT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www everettwa org <br />. . c� I � _ 6�3 <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />LOT NO. <br />DESC. <br />BLOCK I TRACT <br />PARCEL TAX I.D. # <br />PERMIT # <br />�o�lvSl-�I <br />_ � I�i O 1'�..� <br />TENANTNAME � CONTACTFORPERMIT PHONE <br />-/O�� <br />CONTRACTOR Mi l I 2f I�'i<C.�l/IN�'Lct I 1aC. ADDRESS ����3 /CSt1/J�L �C� 21P PHONE yZS�ZU"�/L�j <br />�� r�LlaN����, <br />CONTR. LICENSE p M; /�G M�. GOo iJG <br />USE OF BUILDING <br />WORK DESCRIPTION <br />j t � <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink �service/bar/mop/etc.) <br />BackFlow preventer <br />Urina� <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />�ai« h�.�l�-.� <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />2 ,> c�G <br />NO. I TYPE QF FIXTURE OR ITEM <br />AIC — air handling units <br />Forced air systems <br />Gas piping <br />Wzter heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exh3ustfan <br />Hea:pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES SAX C7DE IS 3105 <br />I hereby ceriti(y that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />' ordinaces go�erning this type of work will be complied wilh �vhether specified herein or not The granting of a permit does not presume <br />to give authority to viQlate or cancel the provision of any other state or local law regulatirg construction or the peAormance of <br />consiruction. That I aln a�thor�'zedby, tte owner of Ihis propeRy to perform the work for which application is made and I comply with the <br />State Contrac:ors Law 18.2YRCW �ad 296.200 WAC. . <br />/�/3/oc� <br />