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PERMIT APPLICATI(�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />��30 <br />� <br />TENANTNAME <br />r►��� 4 >�,.,x�� i <br />CON7RACTOR tarSQn �+C� <br />CON7R. LICENSE 11 r <br />L. <br />USE OF BUILDING <br />PARCEL TAX I.D. A� <br />�5 -q�o-oo2-�1�— <br />��� �+cl►lan� <br />I CONTACT FOR PERMIT <br />YYl ��c� Lai <br />PERMIT A <br />, C�[.�°� -z� <br />QO�j'I�`M � F-rL/ <br />PHONE e <br />.� �� ��� <br />PMONE <br />4�5- 3��-d635 <br />ADDRESS CITY2IP PHONE <br />� oao �k NQ-��is Pr �.-�03 �atrel� q8� y35 <br />HEAT SOURCE <br />� Electric _ Gas _ Olher <br />WORK DESCRIPTION ry� (� <br />�E..�0.K „'✓"1��W1 / RCMO�� QG.MfDOn <br />NO. I TYPE OF FIXTURE OR ITEM <br />( Toilel <br />BalMub <br />( Lavatory (wash basin) <br />I Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbar/mop/etc.) <br />Backtlow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease irap <br />Root drains <br />Olher <br />CONTRACT PRICE OF WORK <br />'�1 /�� .$'-C10, � <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handlfnp units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAl( CODE IS 3105 <br />I hereby cerilify thal I have read and examined this applicalion and know lhe same lo be lrue and correcl. All provisions o( laws and <br />ordinaces governing this lype of work will be complied with whelher specified herein or not. The granting ot a pertnil does not presume <br />to give authority to violate or cancel the provision of any other slate or local law regulaHng constructlon or the perfortnance of <br />construction. That I am authorized by the owner of lhis property to perform the wotk for which applicabon is made and I comply with the <br />State Contractors Law 1827 RCW and�200 W�C. <br />��2 -fJ�o <br />