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PCRMIT APPLICAl"I�N <br />GITY OF EVERETT PERMIT SERVICES <br />5200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />3`i�v5 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE A�DRESS PARCEL TAX I.D. # PERMIT # <br />� l /� .� �l'�C.���T !��iD�-1 <br />LEGALI LOT NO. <br />�ESC.� <br />OWNER <br />� /j � <br />TENANTNAME <br />C�R CTO� <br />� �i., ��i�f�/� � <br />CONTR. LICENSE # ^ t� <br />/J/i li <br />USE OF BUILDING <br />BLOCK I TRACT <br />� � <br />CONTACT FOR PCRMI7 <br />PHONF <br />AD�RESS C TY21P PHONE <br />/'lf� 3 y I I k�,e-=�7�T�'-r ����-�`� F�.-o: <br />WORK. DESCRIPTION <br />� , ��-�--�_ � <br />�9� � <br />NO. � TYPE OF FIXTURE OR ITEM <br />TOilet <br />Bathtub <br />Lavatory (wash basin) <br />�C Shower <br />�G Kitchen sink 8 disposal <br />Dishwasher <br />�_ Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Roof drains <br />Other <br />�� �l � <br />HEATSOURCE <br />Electric �as Other <br />CONTRACT 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 />W ater heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />VJoodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3'105 <br />I hereby ceritify that I have read and examined this applica6on and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type uf work �vill be complied with whether specifed herein or not The granting of a permit does not presume <br />to give authonty to vioiate or cancel the provision of any other state or local law requlating construction or the performance of <br />construction. That I am authorized by the owner of this preperty to perform the work for wnich application is made znd I compiy viith lhe <br />State Cont ctors Law 18.27 RCW and 290.200 WAC. <br />! �i> -��,✓� /%;�i�� � r i - �,� -� <br />