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,� ' <br />��RMIT A��LICATIiN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />P�� sa�-J�� <br />-�� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT <br />SITE ADDRESS <br />6�-o s� �✓G�ET/ xt�u, w <br />PARCEL TAX I.D. # <br />/�� 8o5'3a <br />TRAC7 <br />00 <br /># <br />��,1o,,'�L' V�lv� C.L� l��� 5�1����ds� �il ' '��S -3�3' � <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />5a1 0 O <br />�� �ia :�CN �A �A�M �u�}c ,Z�sr ��o�<y �i,lc, �2 s�,.� ��Fe: ) �.s�i—s-`�-s-a <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />rzEsT�;�� � 3a,v <br />CONTR.LICENSE# �L�rqurr,a,,r '�f��� �o,v('r/L�f�7J8� (��%%y <br />USE OF BUILDING I F{EAT SOURCE <br />f5 ���/+'� �i An.� I —`��c!rin _ Gas _ Other <br />WORK DESCRIPTION <br />�-11�i�IvbL-l�,JGI. ��ei� �ii�/°L�is�v�S <br />NO. I TYpE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Laundry lray <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />/� •� fhc'/t-U/: i o.� !SL l� , S Nc'ti <br />CONTRACT PRICE OF WORK y <br />��5��. ' <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refric�eration <br />Woodslove <br />CITY OF EVERETT LUCAL SALES 7AX CODE IS 9105 <br />I heroby cerilify that I have read and examined lhis application and know the same lo be lrue and correct. All provisions of laws and <br />ordinaces governing lhis lype of work will be compiied wilh whelher specified herein or not. The granling of a permit does not presume <br />to �ive aut nty lo violate or cancel the provision of any other state or local law regulating construction or the performance of <br />conslruction. at I'�m. thorized by lhe owner of this propeAy lo perform the work for which application is made and I compty with lhe <br />State Contr 6 r �27 RCW and 296.'L00 WAC. <br />� i �'�'�'� � � U.� � <br />� �2 <br />:� <br />� <br />