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- PE�MIT APPLICATI� <br />CITY QF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />SITE ADDRESS <br />o s �. <br />LEGA LOT NO. <br />DESC. <br />APPLIC.ATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />r A��C.L W 2�oS/�oajoS�voo <br />BLOCK TRACT <br />:oB�iJsonl pro(�uTies�rNc. <br />TENANTNAME <br />�/� CNIti/tt Bu��j <br />CONTACT FOR PERMIT <br />�MIT # � ` <br />(� � <br />(yzS� j,t�_ <br />> zz7 —�'� 7J— <br />CONTRACTOR ADDRESS CITY/ZIP PHONE �oG� <br />{�c�{-2V'�S f�Ns �12l.iGi � o�J �. C�.�joX ��3GZ jvlkw�La, �3.`7�3� zz <br />CON7R. LICENSE # <br />P� T�-ric � �s� o� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />s�c-rn/s /�Js�tk(-�,��ao•� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Waler healer <br />Sink (service/bar/mop/elc.) <br />Backflow prevenler <br />Urinai <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />4' � I O v v, v�' <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify Ihal I have read and examined lhis applicalion and know lhe same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whelher specified herein or nol. The granting of a permit does not presume <br />to give aulhority to violate or cancel the provision of any olher stale or local law regulaling construction or the per(ormanr.e of <br />cons�ruclion. That I am aulhorized by tlie owner of this property to per(orm lhe work for which application is made and I comply wilh the <br />State S,oqtractors L� 18.27 RCW and 296.200 WAC. <br />(�� �/�.�� 7�z ��� � <br />