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SITE <br />LOT <br />P���VIIT APPLICATiON <br />CITY OF �VERETT PERMIT SEr�VICE� <br />3200 CEDAR STREET, EVERETT, VJA 98 _01 <br />425-257-8810 — FPJ: 425-257-8857 — www.ever�ttwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />BLGCK � TRACT <br />Z-o?�- ' �cJ ��� <br />� c� � �z� <br />Z <br />i` Cti J �' - /J`� <br />�P MIT# <br />c�; L - <br />? r--, C� � G <br />�� <br />� �.�2,J�' _i<7Ci� NS; �c� %�c�!5_;,c +�'�-.. / ��-.ii�. l���� IGoC.,Q/�1•�`'/3 <br />TENANTNAME I CONTCCTrORPERMIT PHONE <br />. � . <br />CONTRACTOR ADDRESS <br />�j .- •�c�� <br />�C.�!C_ 1GI [i� LJ.V -' i �NC_ �c� D�'Y- .?J�._ <br />G^NTR. LICENSE # <br />� <br />��u�,'�=� flfn,7' l <br />USE O� BUILOING <br />�� <br />WQRK DESCP.IPTION <br />NO. I TYPE OF FIXTUR[ OR ITEM <br />Toilet <br />BalhWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundr� �ray <br />Sink (service/bar/mop/etc.) <br />Backfow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CITY/ZIP PHONE <br />�,�:,�- i b� <br />�.�:.� 8'9-���3 <br />HEATSOURCE I <br />Eleclric i� Gas _ Olher <br />�'�f'� �lj•' �� <br />NO. <br />CONTRACT PRICE OF WORK <br /><n �� J C'�.5-7 " <br />Y�i7X�lyyl:�lq�7��l:i11�51 <br />A/C - air handling units <br />Forced air systems <br />Gas pipiny <br />Water heater <br />Gas fireptace <br />Gas ranae <br />Clothc �ryer <br />Range ,iood <br />Ezhauslfan <br />Heatpump <br />Unit healer <br />Boiler <br />Re(rige�ation <br />1Noodstove <br />Olher <br />CITY OF EVERCTT LOCAL SALES T!il( CODE IS 3105 <br />I hereby ceritify that I have read and examined lhis application and know the same to be lrue and correcL All provisions of laws and <br />ordinaccs governing lhis type of work will be complied with whether specifed herein or nol The granting of a permil does not presume <br />to give authority lo violale or cancel ihe provision of any other state or 1oc21 law regulating construction or the periormance of <br />construction. That I am authorized 6y the owner of this property lo perform the work tor which epplication i: �nade and I umply with the <br />State Contractors �avr 18.27 RCW and 296.200 WAC. <br />%/iz/� r' <br />