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SITE AUDRESS <br />LOT NO. <br />DESC. <br />FcI�MIT APPLICI�TIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9820� <br />42u-257-8810 — FAX 425-257-8857 — www.everett�va.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />0 <br />PARCEL TAX I.D. # <br />—UIrP r'03 <br />BLOCK TRACT OR SUBDIVISION N <br />� .Tn�v�r�'��-r l�dci��o� 1�� � � ND <br />0 <br />7-�y-�/ <br />PERMIT # <br />� 90� -/3 <br />1 <br />PHONE <br />o�-Si�—��1� <br />TENANT LnG�lf �--0.ri �•Aef C�bRQ.FO��?l�1 E-MAIL <br />` 3 a'- as 3S <br />CONTRACTOR ADDRESS � CITY/ZIP PHONE <br />!-cscsen Co ns�' £slrtno ►�6tW pue W, �. �02 �v¢�ctl AS��Y 3d7- �s35 <br />CONTR. LICT.NSE N <br />�A�RSEc � la� <br />USE OF �UILDING <br />HEAT SOURCE <br />� Electric _ Gas _ Other <br />WORK DESCRIPTION {,�` L��� I��F' W 111pOW.5 <br />1'� l <br />�f' x6' �ov�Q�o Po���.� <br />NO. I TYPE OF F�XTURE OR ITEM <br />Toilcl <br />Balh!ub <br />Lavatory (wash basin) <br />SIlO1YCf <br />Kilcl �en sink 8 disposal <br />Dishv�asher <br />Clolhes washer <br />Waler healer <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease Irap <br />Roof drains <br />Olher <br />CONTRACT PRICE OF WORK <br />3� LI 6 s, e� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C – air hand!ing unils <br />Forced air syslems <br />Gas pipiny <br />Waler healer <br />Gas lireplace <br />Gas range <br />Cbthes dryer <br />Rangehaod <br />Exhaustfan <br />Heal pump <br />Unil healer <br />P.oiler <br />Refrigeration <br />Woodstove <br />CIN OF EVFRETT LOCAL SALES TAX CODE IS 7105 <br />I hereby cerilify thal I have read and examined lhis application and know the same to be Irue and correcL All provisions ot laws and <br />ordinaces governing this y�pe ot worh will be wmplied with whether specilied herein or noL The granting o( a,�ermit d�es not presume <br />to give authorily lo violate or r,ancel lha provision ot any other stale or local law regulating consVuction or ihe performance of <br />construction. That I am authorized by the owner of lhis property to perform the work for which application is made and I comply with the <br />Stale Conlraclors Law 1f1.27 RCW and 9G200 WAC. <br />�r��.� � �� _ �-aa-�5 <br />SignaWre oi OwnedCoNractodAuthorized Ac�enl Date � <br />z <br />