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P �RMIT APPLICATIvN <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 ACC�PTED <br />SITE ADDRESS <br />8�0 'G"f¢'11`:D �N <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />s�O�t-� C'�16 <br />TENANTNAME <br />� f �� <br />CONTRACTOR <br />CONTR. LICENSE N <br />USE OF BUILDING <br />PARCEL TAX I.D. p <br />2qo518o0�010� <br />� <br />BLOCK TRACT <br />SET� P�A�D �P44f�1�+ <br />ADDRESS CITYIZIP PHONE <br />2Yo7 ea.ey �g�r1oE ��rr 9szo i 4zs.2ss.s9o� <br />CONTACT FOR PERMIT <br />CNucK a'�N <br />� pA�DDRESS <br />�JFI.� —"' -�'j�jOIDQiL *Y-i� �STPSi� <br />�+amE— �s�p�a�es� <br />WORK DESCRIPTION <br />�.�Pc+ME. �SS ABo� <br />HEATSOURCE <br />X Eleclric _ Gas _ Other <br />PHONE <br />q2s.2s2. s400 <br />CITY2IP PHONE <br />CONTRACT PRICE OF WORK <br />�W, o� <br />� L��-�• � o•< • • ��.�• - <br />•� �"I � <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/elc.) <br />Backllow prevenler <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gasrange <br />Cbthes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read ard examined this applicalion and know the same to be true and correct. All provisions of Iaws a id <br />ordinaces governinc� this type of viork will be complied with whether specified herein or not. The granting of a pertnil does not pre,ume <br />to give authority to violate or can,:el the provision of any other state or local law regulating consWcGon or lhe perfortnance of <br />constru n. Th�( I m orized by the owner of this propeAy to per(orm the work tor which applicaGon is made and I comply wilh the <br />Stale ont dclo�s L . RCW and 296.200 WAC. , <br />�Z <br />