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SITE ADDRESS <br />LOT NO. <br />3 <br />TENANT NAME ' <br />�ERMIT APPLICATI�UN <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 <br />PARCEL TAX I.D. A <br />;u�� e05 a= 353 <br />BLOCK TRACT <br />3 53 a��t i <br />ADDRESS <br />r��� ��.,h��d <br />CONTACT RPERMIT <br />i I .� 1 _ <br />CONTRACTOR ��.SC„ �'O�St <br />CONTR. LICENSE N�� p 5�C ' <br />/� <br />USE OF BUILDING <br />ADDRESS <br />ao.�o 1.k E�iqhts pr <br />��� <br />HEAT SOURCE <br />PERMIT / <br />903 -Oa � U�a S - �( � <br />v� 1(e� 3 � dl .��w`s� <br />CITY2IP PHONE <br />Fi�rr'i� � S g= I ao / <br />PHONE <br />3��-aS3S <br />� / j IP�� PHON�, �S� <br />yt� <br />_ Electric � Gas _ Other <br />WORK DESCRIPTION � <br />,,v -�v rn.1 c c <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backtlow prevenler <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />� �g� oa <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas renge <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeratfon <br />Woodstove <br />Other <br />C�TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the samo to be We and cortect. All provisions of laws and <br />ordinaces governing lhis lype of work will be complied with whether specified herein or not. The granting of a pertnit does not presume <br />lo give authority to violate or cancel the provision of any other state or local law regulatlng construction or the perfortnance o( <br />construclion. That I am authorized by lhe owner of this property to peAorm lhe work for which applicadon is made and I comply with the <br />State Contractors Law 18.27 RCW and 296200 WAC. <br />