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F LRMIT APPLICATII�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-^<57-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED �ROM 8 AM TO 4 PM <br />SITE ADDRES5 <br />LOT O.� BLOCK <br />��,7 i���.ia .;,5-.��c� <br />�' [lr i`i :�% <br />�t� vi� <br />TENANTNAME <br />PARCEL TAX I.D. # <br />UDYG 7��'oSc� <br />TRACT OR SUBDIVISION # <br />CONTACT FOR PERMIT <br />C✓�=i'r f-f 9 <br />PHO�E <br />PERMIT # <br />� 7l d 'OD <br />yts = 3i /- <br />Oc� v�i /�%t ��� u � ��! 7- � e-Mni� <br />CONTRACTOR AD�RESS CITYIZIP PHONEy�S= 3�/1-113') <br />W�' ST �'i�sT L�rnc�i���P .c G�tt-tsi3'�rL'�ic� 3i.1 /53'a S� ,SE L yn.t L,�lc� %r'o�' � <br />CONTR. LICENSF # <br />WL=STrL Y yyDVf'I — <br />USE OF 6UILDING <br />WORKDESCRIPTION pE,,,��/�S� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toile� <br />BaU;lub <br />Lavatory (wash basin) <br />Shoc;er <br />Kilclien sink & disposal <br />Dishwasher <br />Clothes washer <br />W ater healer <br />Sink (service/badmop/elc.) <br />Backfloiv preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />HEAiSOURCE <br />Eleclric � Gas _ Olher <br />I�N] <br />CONTRACT PRICE OF WORK <br />NPE OF FIXTURE OR ITEh7 <br />A/C — air handling units <br />Forced air syslems <br />Gas pipinq <br />Waler he�ater <br />Gas freplace <br />Gas renge <br />Cblhes dr/er <br />Range hood <br />E�chaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigaration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I herebVi ceritify lhat I have read and examined this applicalion and know the same to be lrue and correcL All provisions of laws and <br />ordinaces governing lhis type of viork will be complied wi�h whether specified herein or noL The grantina o( a permil does not presume <br />lo give aulhorily lo violate or cancel the prov�sion ot any other stale or local law regulaling construction or the performance of <br />construction. Thal I am authorized by lhe owner o( this properly lo pedorm ihe work tor which app!ication is made and I comply with the <br />Slete�ontractors� j.aw 18.27 RCW and 2�6.200 WAC. <br />