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SITE <br />�4 <br />n <br />PEI��JIIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425- 57-8857 — www.everettwa.org <br />pD�3 J 7oGs��p� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />PARCEL TAX I.D. A <br />'i� �ioZ' oo$� o S <br />BLQGK I No(ki� �(`v QGGf� D 1 V Z <br />J <br />_.. .._. . ..-•-- <br />HAAck �-n�s coNs�, .��,�, �� �� e���rr �a� 4zS- 39 �-7366 <br />TENANTNAME I CONTACTFORPERMIT PNONE <br />Soel l-laack Nds-a9o-a�ia9 <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />��RAcic [iRu7i�ERs 3�122 e7+�/WE. �[C- �cr�e�rr 9btos <br />CONTR. UCENSE N - <br />I�p�c-k <br />USE OF BUILDING <br />N Ew SF� <br />WORK DESCRIPTION <br />� �w <br />HEATSOURCE <br />_ Electric � Gas _ Other <br />s F i� ao�s b`�F. <br />PLUMBING <br />NO. I TYPE OF FIX7URE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />� <br />tiu 3��-� 3bo <br />CONTRACT PRICE OF WORK <br />/2oK <br />i�`���70 <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heatar <br />Gas fireplace <br />Gas range <br />Clothes dryei <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />RehigeraUon <br />Woodstove <br />Othar <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS J105 <br />I hereby ceritify that I have read and examined this applicatlon and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The grantlng of a permit doea not presume <br />to give authoriry to violate or cancel the provision of any olher state or local law regulating constructlon or the performance of <br />construction. That I om authorized by th�ryN ner of this property to perform the work for which appiicatlon is made and I comply with the <br />9Fele Contractbis Law 18.27 �FCIOL and 196.200 WAC. <br />1� <br />