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P�RMlT APPLICATIG�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9820 i <br />425-257-8810 — FAX 425-257-8857 — wv,iw.everettwa.org <br />�, -�3-a` f <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # / <br />f o 7 S � �+/,y.PF� /LI �L L �l � �C (,� l / "' 6 / �� <br />LOT NO. I BLOCK <br />TENANTNAME <br />CONTACT FOR PERMIT <br />MG cG/ o _ <br />CONTRACTOR Q� L.O��Sarrd�.� ADDRESSa-i'�G�d � 6✓ CITYlZIP <br />� Co�r�ucf '�-, �/ir:+oc�s c7.� -�� �ccsr3oi2a <br />CONTR. LICENSE � pe i � G�c ��� 7�3-3 <br />I P O /,(`� � <br />USE OF BUILDING <br />WORK DESCRIPTION <br />HEATSOURCE <br />Electric Gas Other <br />��?��L S L(,��"/L� S/ G1-� S <br />PLUMBING '' <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <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 />Urinal <br />Drinking Fountain <br />Flcor drain <br />Grease trap <br />Roof drains <br />Other <br />PHONE <br />PHONE (��..3� <br />Io6i7_ 3 J 7 y <br />� <br />CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />N�ater heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />8oiler <br />Refrigeration <br />Woodstove <br />Olher <br />�-,.ez S�. ;P,.�s..:� sy��..--. <br />I£� ,` `l/`� �a : + r-�-,L-�-' � <br />CITI' OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify tnat I have read and examined this application and kno�v ihe same to be true and correct. P.II provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local �aw regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perfcnn the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />�LG� ���. � //—�3_ <br />