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SITE ADURESS <br />LEGA LO� <br />DESC. �Lj �- <br />OWNER <br />��i�r� ', <br />TENANT NAIAE <br />PErtMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />4?5-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />PARCEL TAX I.D. # <br />DUC:, I � L�voO IO'�oO <br />TRACT <br />�I�o�v ��2Z1 l <br />CONTACTFOR <br />CONTRACTOR � 14 � � C C.v'i'/ <br />b <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />� � AODRESS / I�I� I � q�.vt� <br />�: o ,U �,. <br />HEATSOURCE <br />CITY'21P <br />�j ��z�-3 <br />A�I,Ny �-� <br />Electric Gas Olher <br />NO. ' TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shuwer <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heafer <br />Sink (service/bar/mop/etc.) <br />Back(low prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. <br />MIT p <br />� 1� <br />PHONE <br />PHONE <br />(�/7� � <br />s3o-ca�� � I <br />CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT L6CAL SALES TAX CODE IS 3105 <br />I hereby ceritify lhal I have read and examined ihis application and know the same to be lrue and correcL All provisions of laws and <br />ordinaces governing this lype of work will be complied �vith whether specified herein or n�il. The granling of a permil does not presume <br />to give authoriry ro violale or cancel Ihe provision of any other state or Iocal law regulating construcGon or tiiu oerfortnance of <br />conslruclion. That I am authorized by Iho owner o( this property to perform the work for which applicalion is mada and I comply with lhe <br />State Contractors Law 18.27 RCW and296200 WAC. <br />-a�- v�-- <br />