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, <br />P��RMIT APPLICATIGnI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org � ��/� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS AR ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. N PERMIT t <br />39a5 !�i h �• oo �oos-oa3—oo !3 -al <br />D SC. LO�O''. ��'I ' BL[CK TRAC�m� ' _ I �. �O� � _ ^u <br />ti ) .J ha/10� T� { 7 <br />_� <br />r� <br />'Pt,/a <br />�0.f$eP1 ConS� <br />CONTR. LICENSE N <br />USE OF BUILDING <br />s /��kh s+� � <br />CONTACT FOR PERMR <br />ADDRESS <br />i� b'�� �r" P.L s F <br />WORK DESCRIP �.ON p <br />�ui� �Jnc��.tlun <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash hasin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Ur:nal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Root drains <br />Other <br />PHONE <br />�,�- 3��- �s3s <br />FITY/LIP PHONE <br />Snol�omirl, qp�'i� N�tS'- 3A7- �s3s <br />HEATSOURCE <br />�, Electric _ Gas _ Other <br />'Cdl <br />CONTRACT PRICE OF WORK <br />� 73�0,�° <br />TYPE OF FIXiURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas renge <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />Other <br />� � i('Jlll{�/t/ �271'1�4'�/ I I <br />CITY OF EVERETT LOCAL SALES T: x CODE IS 3705 <br />I hereby ceritify that 1 have read and examined this applicalion and know lhe same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied wilh whether specified hereln or not. The granting of a perm(t does not presume <br />to give authority to violate or cancel the provision ot any other state or local law regulaUng construction or the performancs of <br />construction. That I am authorized by lhe owner of this property to perfortn the vrork for which applicadon is made and I comply with the <br />Slate Conlractors Law 18.27 RCW ar�296.200 WAC. <br />1 3 -OS <br />`�2 <br />