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SITE AD�RESS <br />3�2 , <br />LEGAL L�JT NO. <br />DESC. <br />TENANTNAME <br />r �RMIT APPLICATiJN <br />CITY OF EVERETT P�RMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-?_57-8857 - vnvw.everettwa.ory <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �— � 2�O� <br />PARCEL TAX I.D. # PERMIT # <br />S r I�%1 �''1C� �' b�� <br />BLOCK TRACT OR SUBDNISION # <br />� 1 Z Wlcc)� <br />CONTACT FOR PERPAIT <br />s�,zc3 ..._._ �,Lc <br />PHONE <br />� E•MAIL <br />CONTRACTOR 1��1�t� �,�}.�S ADDRESS��Z��y ���� CITY/ZIP P�!JNE <br />--� " 5 <br />CONTR. LICENSE # <br />IfSE OF BUILDING <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhlub <br />Lavatory (wash basin) <br />Shotver <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lraN <br />Roof drains <br />Other <br />LS � o: <br />HEATSOURCE <br />i Eleclric _ Gas _ Olher <br />NO. <br />.sC..�- %�U`'U!(�Z <br />CONTRACT PRICE OF WORK <br />�,� <br />NPE OF FIXTURE OR ITEM <br />NC — air handling units <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />I hereby cerifi(y lhat I have read and examined this application and know the sama to be lrue and correct. Alf provisions of laws and <br />ordinaces governing lhis type of work will be co:nplied with whelher speci(ied herein or not. The granting of a permit does not presume <br />lo give authority to violate or cancel the provision of any other state or local law reyulating construction or lhe peAormance of <br />construction. That I am authorized by lhe owner of lhis property to perform the work for which application is made and I comply with the <br />State Contraclors Law 18.27 RCW and 296.200 WAC. <br />�h � , i � �. �.. _.... 1 � �'2'� o S — <br />� <br />