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� <br />PEar�MIT APPLIC�iIO�J <br />CITY OF EVERETT PERMIT SERVICES /� -���'C� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-25 T-8857 — www.everettwa.org <br />�4/0 -.�S <br />APPLICATIONS ARE ACCEPTED FRO!A 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />�/� ���1��� <br />LEGA�C. <br />/��'� /�i!� <br />TENANTNAME <br />PARCEL TAX I.D. # <br />TRACT <br />� <br />ADDRESS CITY2IP PHONE <br />S%/ G.Gi1��L ,ES��iT �.Gz ° � <br />CONTRACTOR <br />C�'�,1.<j� cv.tfl�G�c',�7v-� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />CONTACT FOR PERM11IT <br />ADORESS <br />CIlY21P <br />fyl�i::�G7D�/ <br />f1EAT SOURCE <br />_ Electric _ Gas _ Olher <br />�'T.�i.c/i.c/l,' C.�41_L �L i` .�GGL'J' <br />NO. I TYPE OF FI�CTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />f<itchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fcuntain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />pHr.:�e <br />PHONE <br />CONTRF�GT PRIGE OF WORK <br />C�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC — air handling units <br />Forced air systems <br />Gas pipiny <br />W ater 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 />Retrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� I hereby ceritiy that I have read and examined this application and knrnv the same to be true and correot. All provisions of laws and <br />� ordinaces goveming this rype of work will be complied with whether sp�ci�ied herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regul2tirg constructlon or the performance of <br />�� constru�tion. That I am authorized by the owner of this property to perfnrn the wo�K ror which application is made and I comply with lhe <br />State Contractors Law 18.27 t2CW and 296200 WAC. <br />�l7�riG� /o-.yS-�i= <br />