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E �RMIT APPLICAT�.�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STFiEET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everethva.org <br />/� 3 -d�' <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE <br />DESC. <br /><LJ� <br />Z /,r�p,��J <br />LOT NO. BLOCK TRACT <br />/ ADDRE <br />L .1 . /' � � � <br />TENANTNAME <br />PARCEL TAX I.D. # <br />CONT,pFT FOR PERMlT <br />CONTRACTOR ADORESS <br />�,,�L�S S���iC� P�rt��.L'� i'-'S <br />CONTR. LICENSE # _ <br />USE 6F BUILDING <br />WORK DESCRIPTION <br />HEATSOURCE <br />Electric �Gas Other <br />l�'�tvC r.� � � ,t- ��''`�-t-- ��`�" <br />NO. I IYPE O� FIXTURE OR ITEM <br />Toilet <br />BatMub <br />Lavalory (wash hasin) <br />Shower <br />Kitchen sink 8 dispo�al <br />Clolhes wasiier <br />Laundry tray <br />Sink (servicelbar/mop/etc.) <br />Backflow preventer <br />Urinal <br />DrinKing Fo�ntain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other _z � .�' <br />U�-�^�— <br />rn�rl,C <br />1.�1 LcS <br />;�3 i�z <br />PHONE <br />CITY/ZIP PHONE <br />y L.s - 3�/ <br />G-� s5 <br />COIvTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Ctothes dryer <br />P,ange hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />_I Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3'105 <br />I hereby ceriti(y that I have read and examined this application and know the same to be true and ccrrect. .411 provisions of laws and <br />ordinaces governing this rype of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to c�ive au[honry to violate or cancel the provision of any other state or local law regWating constn�ctlon or the performance of <br />construction. That I am authorized by the owner nf this property to perorm the �vork for which application is made and I comply �.vilh the <br />State Con,ractors Law �8.27 RC'✓V and 256.200 WAC. [ <br />: �/,�/i�i7,9nw.wU /%-/ ��(%`D <br />