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PE,<MI�' AF'PLICATIO�d <br />CITY OF EVERETT 'EF�MIT S�RViCES � <br />3200 CEDAR STREET, cVERETT, WA 98201 � <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.ora Y`�� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - pEBIT & CREDIT CARD� ARE NOT ACCEPTED <br />SITE ADDRESS <br />si/ L-���/�`G <br />DESC. <br />LOT NO. I BLOCK <br />7a/� f�.B�C/✓ <br />TENANTNAME <br />CONTRACTOR <br />c o �4'.4�C c.� i�.— <br />CONTR. LICENSE # <br />USE OF BUILDING <br />f�/��- <br />WORK DESCRIPTION <br />TZACT <br />PARCEL TAX I.D. # <br />���� �-�.��� ��.�.�r <br />. Si/ L��/��L <br />PERMI7 � <br />i� Ud��_ <br />CITY2IP PHONE <br />�i�T 9z,� � =.��-ZG_4b <br />. <br />CONTACT FOR PERMIT PHONE <br />.4.�/OY f�.�GC stL �-zs7-c B'Fd <br />ADORESS CI7Y(ZIP PHONE <br />��i,�c�v-� 36�- 45s= r9g� <br />HEATSOURCE <br />_ Elec,ric �Gas _ Other <br />��"//af�L �i� ,�X/,j���� �i6�J� <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEA7 <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Flcor drain <br />Grease trap <br />Roo( drains <br />Other <br />CONTRACT PRICE OF WORK <br />� O O� 000 . w <br />NO. I TYPE UF FIXTURE OR ITEM <br />A1C - air handling units <br />� Forcedairsystems <br />Css piping �,' �! <br />'� Water heater <br />Gas fireplace / <br />[� Gas range <br />LL Clothes dryer <br />� Range hood <br />� Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />WooAstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 11U5 <br />I hereby ceritify that I have read and examined this application and know the same to be true and wrrect. Ail provisions of laws and <br />ordin2ws goveming this type of work will be complied with whetlier spEcified herein or not. The gran;ing of a perr�it dues not presume <br />to give authonty to violate or cancei lhe provision of an�� other state or Iocai law regitlating constn:ction or the performance of <br />construcuo That I am authorized by the owner of this property to perform the work for which application is made a�d I comply with the <br />State Co rac s Law 19.27 RC a 296.200 WAC. <br />�_��C«� j�"- !�-�� %-z-'-'4- i <br />