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� <br />PE��MIT �4PPLICA►TION <br />CITY OF E,VERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.crg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DkBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADORESS <br />J y� , <br />LEGAL LOT N0. BLOCK <br />DESC. <br />OWNER <br />�G"�iN!i � />/'Vi,c��iJ <br />TENANTNAME <br />CONTRAC70R <br />UWNF_2 <br />CONTR. I.ICENSE # <br />USE OF BUILDING <br />WOF.K DESCRIPTION . <br />; __/!/.��ti� (.c��,J <br />��f ��/ ti�� <br />d,��/c1 /G�- S/ "�.'"� l�r�; <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />ToilE4 f" ` <br />Bathtub <br />Lnvatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dish�vasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />U inal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />PARCEL TP.X I.D. # <br />��13G�9 r�Z <br />17:1dN� <br />CONTACS <br />PHONE <br />_ �, �� x �r �6��E, <br />A�DRESS CITY2IP PHONE <br />.� <br />HEATSOURCE <br />_ Electric G Gas _ Other <br />� <br />i. <br />CONTRACT PRICE OF WORK <br />�BDoo"' <br />/�. /C'/a��% � �°'1'��i4-W C� <br />� ���/ s��.�.;�,�� � as� <br />�,..�/'/J-{- /J,n�i.sv. . SritoKE J�(J�Rw�S <br />NO. <br />TYPE UF FIXTUR[ OR ITEM <br />A/C — air handling units <br />�orced air systems a;A�'• <br />Gas piping <br />Water heater <br />Gas (ireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unit heater <br />Boiler <br />Retrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />�� I here6y ceritify that I hav= read and examined this application and know the same to be true antl correct. Ah provisions oi laws and <br />ordinaces governing this ty�e of work will he complied with �vhether specifed herein or not. The granting cf a permit does not presume <br />lo give authonty to violate or cancel the prcvision of any other state or:ocal law regulatinp constructlon or the performance of <br />consr.uction. Tha[ I am authorized by the owner of this property to periorm the work for wnich application is made and I compiy with the <br />Stat:; Contractors Law 1827 RCW and 296.200 WAC. <br />��� � � � -�� � <br />�„na[ure of �nenContractonAuthonzetl Agent Date � Z <br />