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P�_RMIT APPLICATIVN <br />CITY OF F_VERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evereriwa.org <br />GJ �(o - / � <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # ERM�IT j/� <br />.i... �. i /. w I ��._...........__'ii._ �iti/l�r/"�� <br />LOT NO. I BLOCK I TRACT <br />DESC. <br />(ti.tS) <br />�enn� c c.���.P �oc�C�r N�1i�k y�az •$'eu l,�<� .� �Sfr-6]90 <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />1i�nn;S �CC� Nd3-a5,5- 679�% <br />CONTRACTOR <br />CONTR. IICENSE # <br />USE OF BUILDING <br />�� �e S . <br />WORK DESCRIPTION <br />/1'� �, <br />N��S� <br />NO. I TYPE OF FIXTURF OR ITEM <br />� Toilet ''�' <br />� BathWb li <br />�_ Lavatory (wash basin) y/J <br />�Shower i • <br />Kitchen sick 8 disposal <br />1 Dishwash�r <br />�_ Clothes washer <br />� Laundry tray <br />� Sink (service/bar/mopletc.) <br />Back(low prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />ADDRESS <br />HEATSOURCE <br />DC Electric Gas Other <br />N0. <br />—i <br />41c .�d"! - 9.To 5� <br />CITYIZIP PHONE <br />CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaust fan /�; <br />Heal pump <br />Unit healer <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby ceritify that I have read and examined lhis applicalion and know the same to be true and correct. All provisions of laws and <br />ordinaces governing lhis type of work will be complied wilh whether specified herein or not. The granting of a permit does nol presume <br />to give aulhorily to violate or cancel the provision of any olher state or local law regulating construclion or the pedormance of <br />construction. Thal I am aulhorized by lhe owner o( this property lo perfonn the work for which application is made and I comply with the <br />state Contractors Law 18.27 RCW aod 296.200 WAC. <br />7- %� " ZU�C <br />� — <br />� _ ; �" _. , . <br />��� <br />