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PE�MIT APPLICATIO�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETi', 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 />SITF ADDRESS � / <br />�LZI Y�_ /o✓�`X A�C <br />,� LOT NO. BLOCK <br />�/ �'�Z <br />ER�/� <br />/� I�tr�l�h V•'6`^ ��...J(�' N <br />TENANTNAME <br />CONTI2ACTOR <br />CONTR. LICENSE # �� (F <br />USE OF BUIL�/]DING <br />(\1 ��LL I <br />WORK DESCRIPTION <br />h�e rs��u���s�� <br />,�,o��/ �:(n��- b <br />I ✓nlfLe -�+c <br />NO. I TYPE O� 9XTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />C�othes washer <br />Laundry tray <br />Sink (servicelbar/mcp/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />I PARCEL TAX I.D. # PERMIT p <br />bOLl3 �S ��' bolDO �.�cJ�": <br />TRACT <br />ADDRESS CITY2IP PHONE <br />l/ozo �horl� ��� L.:,,('�Sfc��c 98�� �lZ.s-�- <br />CONTACT FOR PERMIT PHONE <br />�1�, �/, � U� L�:....,�... �zs �a� - �uz- <br />AD�RESS <br />HEATSOURCE <br />�, Electric _ Gas _ Other <br />�I `�b s�erz ,i-(�i,.x.s. <br />�.�.nb��.a s{��io�+--. <br />J J <br />CITY2IP PHONE <br />CONTRACT PRICE OF WORK <br />'� �SO. 0 U <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling urits <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas firepiace <br />Gas renge <br />Clothes 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 SAX CODE IS 3105 <br />i I hereby ceritify ihat I have read and examined this application and know the same to be true and correct. All provisions of Iaws and <br />i ordinaces goveming this type of work will be complied with whe:her specified herein or not. The grantlng of a permit does not presume <br />i to oive authority to violate or cancel the provision of any other state or local law regulaling construction or the perfortnance of <br />� construction. That I am aut orized by the owner of this property to perform the work tor whic` application is made and I comply with the <br />i State Contractors 4aw ].8��7 RG.N aod 296.200 WAC. <br />