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PEr2MIT APPLICATIOnI <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. # PERMIT # <br />uill� 6FtAn�O fj�E_ noS9�Zm9aiior� � c�`>3 � 3 <br />LEGAL LOTNO. BLOCK TRACT <br />DESC. j � A.1 Z c��f - �-oo -rE�r�� Ano�n� ra r-vr-R�r�– — <br />JoFw �o�so�i�r4 <br />TENANTNAME <br />�/,QCANT <br />CONTRACTOR <br />CONTR. LICE�SE ri <br />USE OF BUILDING <br />O WNfiIZ <br />PRoD��c � �z�G <br />S1n14�E- F�'�'�• /'-�S�o�'� <br />l�Z(� Rucr<��- � �Vr�T 9�z�� o.Tsi <br />CONTACT FOR PERMIT PHONE <br />ow,�.�r-.�2_ u LS - Z 3 Z- ( �l8 �Z <br />ADDRESS CITY2IP PHONE <br />HEAT SOURCE <br />� Electric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />I,VTt'r��o�L R�oU�c� oF r>-95�iHr.�,--� (2i4�5� tlou5� � 1-C-�f� <br />G, �r� i•'c"� �v:.'1 � 77.�Zi ._ �l7fAr t!G'T <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Oishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYFE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />W ater heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pumN <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />C!TY OF EVERETT LOCAL SALES 7AX CODE IS 7105 <br />I hereby cerilify that I have read and examined this application and know the same to be true and correct. 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 pertnit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am authonzed by the o�vner of this property to perform the work for which application is made and I comply with the <br />Slate Conlractors Law 18.27 RCW and 296.200 WAC. <br />�-��� �—�—OS <br />� � <br />Signawre nenC��tre�%rlAu'honzedAgent Date � <br />� <br />