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PE� �2MIT 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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERM T A� <br />�Ub�� �I�.�CIii �(/.(_ L��'�' <br />LEGA LOTNO. BLOCK TRACT <br />DESC. <br />�V-iNll �{��'cl.i C �� <br />TENANTNAME <br />CONTRACTOR <br />J< < <br />CONTR. LIC NSE # <br />USE OF BUILDING <br />J%��� �;7fX-cCt7� L,[/-C G.Gf <br />CONTACT FOR PERMIT <br />�ILIA,�/% kG�t�!-�[ C�� <br />ADDRE55 <br />CITY2IP <br />G��! �(i z.�� i0�06'Lr <br />PHONE <br />�j z 7�,�c, [l c g <br />PHONE <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric Gas Other <br />WORK DESCRIPTION / �.l`C �� ,� �� <br />C�U,�� V.l' . ti'�-t '� i-i wtQ .$ 4t-(� WW �- �� <br />1�ta � J ii:c �`-I'— ��J l J�yl /C� � <br />a- c �� <br />N0. I TYPE OF FIXTURE OR ITEM <br />�r Tailet <br />� Bathlub <br />� Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badiiiop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Fioor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. <br />�� <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling 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 />Refrigeretion <br />Woodstove <br />Olhar <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />i hereby ceritify that I have read and examined this application and know the same to be true and �orrect. All provisions of laws and <br />ordinaces governing this rype of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provis�on of any other state or local law regulating construction or the performance of <br />cnnstruction. That I am authorized by the owner of this property to periorm the work for which applir,atlon is made and I comply with the <br />Sta;� Contractnrs Law 18.27 RCIN and 296200 WAC. <br />�. G. IC,- � r-�.-C, <� — — <br />�' - i5 p� <br />