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PERMIT APPLICATION <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 />SITE ADDRESS <br />/�00 (.� f/UL.6'f'De�if �VE <br />LEGAL LOTNO. BLOCK <br />DESC. <br />/7�C./ � /✓,vL"'' �C�n: S i <br />TENANTNAME <br />PARCEL TAX I.D. N <br />TRACT <br />CONTACTFORPERMIT <br />CONTRACTOR �����Nf��ti �J��yrC ADDRESS CITYILP <br />��"� .�= t r/� � /'[�ti <br />CONTR. LICENSE • <br />2n/��N/'�z��c Z <br />USE OF BUILDING <br />S F"2 <br />J�j3� i z✓,�. .J� ��-. � 9,� �� 3 <br />HEATSOURCE <br />_ Eledric _ Gas _ Other <br />WORK DESCRIPTION <br />/ni.`� /. �zt /-_i/'C' Si-:�..�-.(l��.l', <br />N0. I NPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Cloihes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />BackAow preventer <br />Urinal <br />Drinking Fountain <br />Floor drein <br />Grease trap <br />Roof drains <br />Other <br />oS — � <br />PHONE <br />PHONE <br />360 � Yu3->yc <br />CONTRACT PRICE OF WORK <br />�.�,�.. J -v <br />/N %✓L 7L S Fj� <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Rangehood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />Z SP,e...�✓_c��5 <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �705 <br />I hereby ceritiy that I have read and examined thls application and know the same to be true and cortecl. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a pertnit dces not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the pedortnance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18,27�CW and 296.200 WAC. <br />