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PtF�MI�' APP�ICATIUN <br />CiTY OF EVERc i T PERMIT SERVICES <br />3200 CEDP.R STREET, EVFRETT, WA 98201 <br />425-257-II810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDReSS <br />`/(?�„�'G (�CY�,., �� /;ihil� ���•-Cj����'� <br />LOT N0. � BLOCK <br />DESC. <br />TENANT NAME <br />� <br />7/u� ky z E; L� <br />CONTRACTOR <br />�;>u[' l��z:S�C��-E./� <br />CONTR LICENSE# C`,LUI <br />PARCEL TAX I.D. # <br />TRtiCT <br />RMIT i' <br />? G[-(i� <br />I CONTACT FOR PERMIT PHONE <br />� �� C'� ��' f �rP c)^ I Z� <br />�;�i�y�-( /1`iC� l£,�. c c c �� � K 5�' <br />ADDRESS CITYIZIP PHONE ;1 <br />. l` �I <br />� 1 1�-�,' �� � 7� C �� �t� e� yL�7-��.il L��ilcl';"� i 3'j s"`i I� � <br />��u� �c�- � s:�c Z. << �� �y;,�� ,� <br />USE OF BUiLDING <br />�u��� e`-��r'ice ���D�� J�x«t <br />HEAT SOURCE <br />_ Electric _ Gas _ Other <br />WORK DESCRIPTION <br />i��l�!% L�'�t ��5 � j �f00%� , %�C[�'�i1P�% i�� %��%ziti'f-r� Ct 2��z;; �JCt;�i � <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BalhWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry lray <br />Sink !service/bar/mop/etc.) <br />Backflow preveoter <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />CONTRACT PRICE OF tiNORK <br />i � OOc: <br />N0. I TYPE OF FIXTURE OR ITEM <br />A1C — air handling units <br />Forced air systems <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 />Refrigera6on <br />Woodslov ., : . <br />� Olher ,�1� ��JD L'r�r'rCc�S c. - <br />,K, fc/irrl CL 1tn LU� ti!0 -.`Y�7lL <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify lhat I hz�ae read and examined this application and know lhe same to be true and correct. All provisions of laws and <br />ordinaces governing �his type of work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />to give authoriry to violate or cancel the provision of any olher stale or local law regulating construction or the perfo� �nance of <br />conslruclion. That I am aulhorized by the owner of this property to perform the work for which application is made and I comply with lhe <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />--��i:h�,�� /)Le �L�� � l'/7-L`'% <br />