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P�RMIT APPLICATIC,N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org (,� `��`b� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CRE�IT CARDS ARE NOT ACCEPTED <br />SITE ADD <br />LOTNO. I BLOCK � TRACT <br />DESC. <br />PARCEL TAX I.D. # <br />PERMIT # <br />�o�l6u-u�O <br />�%iT ��i/UL, /-I � �l �� � �,DC!/�P� 1-7 f �� �� ���7� � ��D� <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />CONTRACTOR <br />CONTR. LICENSE # <br />C � I--� c1a-; <br />_ ..,• CMN � <br />USE OF BUILDING <br />WORK DESCRIPTION <br />I N 5T� �- L <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 />Clo!hes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Diinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />ADORE55 <br />lU1S <br />* �i S�Ry <br />CITY2IP PHONE <br />�L_G�.%'c�.�1 (�V"�[�'�' <br />� �iBZo� <br />I — HEATSOURCE <br />Electric � Gas Other <br />�Ii�EPtiH�.�` <br />NO. I <br />`--125 <br />�'4 U � � <br />CONTRACT PRICE OF WQRK <br />3,�00.� <br />TYPE OF FIXTURE OR ITEh! <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />exhaustfan <br />Heatpump <br />Unit heater <br />Bailer <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETf LOCAL SALES 7AX CODE IS 9705 <br />I hereby ceritify that I havc read and eRamined this application and know the samz to be true and correct. AU provisions of laws and <br />ordinaces governing this type of work will be complied with wnether specified herein or not. The granting of a permit does not presume <br />to give authonty tc �iolate or cancel the provisien of any oGier state or local law regulating construction or the performance of <br />construclion. That I am authorized by the owner of this property to perform the work for which application is c,,;de and I comply with lhe <br />State CIontractors Law 18.27 RCW and 296.200 WAC. p -7 <br />C�ClJ1/%211'd� �1i1'I�,�l-�i � l • �� "0 7 <br />