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P�,r�MIT APPLICAI`IG�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-881 U— FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM A AM TO 4 PM - DEBIT 8 CREDIT CAR�S ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERM17 � <br />�j � D.S i'ioy+ ANe.-.u� '�-Z �l� ��3� � %SC.�. G63 �''d � C��,— (�O� <br />LO7 <br />� <br />BLOCK � iRACT <br />TENANT NAME CONTA1CT FOR PE/R..�MIT <br />��C�1QG� �Gl_O�ra6tlt I �:Lh�GI Ilt�r.tiaC� <br />CONTftACTOR � QODRESS CITY2IP <br />"�' , �'J�.Sk.ae_ i%G�-''��_ <br />�u��ti� � � <br />CONTR. LICE SE # _ � <br />USE OF BUILDING <br />G���ti�:a� <br />WORK DESCRIPTION <br />�j�iG� �/ � � ��t"--� <br />NO. I NPE OF FIXTURE OR ITEM <br />Toilet <br />8ath:ub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/barlmop/etc.) <br />Backtlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Gn=ase trap <br />Roof drains <br />Other <br />HEATSOURCE <br />✓ Elec.ric _ Gas _ Other <br />PHONE �y�S� <br />257-1�.3Co <br />PHONE <br />CONTRAC�T, PRICE OF WORK <br />i/ <br />l� 5 � <br />NO. � TYPE OF FIXTUkE OR ITEM <br />A1G — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />� I hereby ceriti(y that I have rsad and examined this application and know the same to be true and correct. All provisions of laws and <br />� ordinaces governing this type ot work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authonty to violate or cancel the provision of any other state or lo�al law regulating construction or the performance of <br />:onstruction. That I am authorized by the owner of this property to peAorm the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />zooj� <br />Date �/� <br />