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SITE A�DRESS <br />"' : 's. <br />LEGAL �` LOT NO. <br />' ,�. e <br />TENANTNAME <br />PEr2MIT APPLICATIOtv <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8R10 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br />BLOCK <br />CON7RACTOR <br />�< <rf.a > s��. ��r . s,�':�����,� <br />CONTR. LICENSE # <br />USE OF BUILDiNG <br />� <br />PARCEL TAX I.D. # <br />TRACT <br />le�Z� <br />�±—lb-o7 <br />PERMIT # <br />i�.,r,��,s��� _ t—�xat� /`r S u ��i <br />CONTACT FOR PERMIT P ONE <br />S�Z S'"- 7✓"r/ —,� Z'j S G <br />�*t � C.�C,,zss� y as = 3,� � - �s".��'/ � � <br />ADDftESS CITY2IP PHONE <br />y�s _ 3f7�- 9s+/ z_ <br />WORKDESCRIPTION ��.'�I-�E`.`•IJ��.I_"�I!.P' <br />NO. I NPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash 6asin} <br />Shower <br />Kilche� sink & dispnsal <br />Dishwasher <br />Clothes washer <br />Waler healer <br />Sink (service/bar/mop/etc.) <br />Backtlow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Cther <br />�v�c/ �t vcr - <br />HEATSOURCE <br />Eleclric Gas Olher <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />� Gas pipinc� <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangc hood <br />Exhaustfan <br />Heal pump <br />� Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify lhat I have read and examined this application and know the same to be lrue and correct All provisions of laws and <br />erdinaces goveming this type of work will bo wmplied with whether specified herein or not. Tho grenting of a permit does not presume <br />to give authonty te violate or cancel the provision of any olher statz or local law regulaling construction or the per(ormance of <br />construc!ion. That I am authorized by the owner of this prop�rty lo perform the work for which application is made and I comply wilh the <br />St2te Conlractors Law 1827 RCW and 29�.200 WAC. <br />Signalure ot OwnedContractor/Authorized Agent Date <br />