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PE�RMIT APPLICATIO�N <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 2�,.� <br />SITEADDRESS /tve�.���� W{.� <br />���� v�v� �'G' <br />�'PtV lD P�1. i�S�tJ`�P� <br />TENANTNAME <br />�� M� <br />CONTRACTOR <br />CONTR. LICENSE ff <br />USE OF BUILDING <br />1"�✓- <br />WORK DESCRIPTION <br />(� PtP�N(J- <br />PARCEL TAX I.D. N <br />TRACT <br />�(oc�l (�n � <br />C�U, 4Z53z$ 73 <br />CITY2IP E <br />��fIK-iT, �.Uq °18201 i zo�o <br />'ONTACT FOR PERMR <br />�1Z5 37�-7388 �'�� <br />ADDRESS <br />��� <br />NO. I 7YPE OP FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sfnk & tlisposal <br />Dishwasher <br />Clathes washar <br />Water heater <br />Sink !�ervicelbadmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drafn <br />Grease trap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ ElecWc _ Gas _ Other <br />cmruP �+a+e <br />CONTRACT PWCE OF WORh <br />NO. I 7YPE OF FIX7URE OR IiEM <br />A/C — afr handlfng unHs <br />Forced air systema <br />Ges pipinp <br />Water heater <br />Gas flreplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Ezhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeradon <br />WoodsWve <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby ceritify thal I have read and examined this applicaUon and krrow lhe same to be We and corteG. All provisiona af lews and <br />ordinaces gaveming this rype of work will be complied wfth whether specified herefn or not The grentinp of a pertNt does nol presume <br />to glve authority to violate or es�cel the provision of any oGtier state or bcal law reguladnp canaWctlon or the parformance of <br />struclion. That I am authorized by the owner of this propeAy to perfortn the work for which appl{catlon (s made and I comply with the <br />St Contracl�rs w 18.27 R�w 96.200 WAC. I <br />1�. n,�rt� I�� _ r1o�t�'uRt� 2/ Zl n7 <br />