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P'�RMIT APPLICATId�� <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 3 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRES PARCEL TAX I.D. N PERMIT <br />� D l A�/2�Cu ►�.i� 14tJ�, y�nc��D�-o�- � <br />LOT NO. I BLOCK I <br />� Sl�err� <br />� <br />TENANTNAME <br />I 1 (S��Pi <br />CONTRACTOR ��/ <br />CONTR. LICENSE k <br />USE OF BUILDING <br />WORK DESCRIPTION <br />(�.�P��.�d <br />e(CP �(cs ��pe <br />NO. � TYPE OF f iXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwashor <br />Clothes washer <br />Laundry tray <br />Sink (servicelbar/mopletc.) <br />Backflow proventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />TRACT <br />Z�s33-co�`�' <br />CONTACT FOR PERMR <br />ADDRESS <br />yk �UY "" <br />Se. G�z✓�, (�h 3'��-�v83 <br />PHONE <br />CITY2IP PHONE <br />HEATSOURCE <br />_ ElecMc �Gas _ Other <br />CONTRACT PRICE OF WORK <br />�a�� <br />NO. I 7YPE OF FU(TURE OR ITEM <br />A/C — air handling uNts <br />Forced atr systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Cbthes dryer <br />Ranye hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Bofler <br />Refdgeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby ceritify that I have read and examined this applfcatlon and know the same to be true and correct. All provisions of laws and <br />ordinaces goveming this rype of work will be complied with whether specified herein or not. The grantlng of a pertnit does not presume <br />to give authoriry to violate or cancel Ihe pFovision of any other state ar Iocai law regulating construction or the perfortnance of <br />construction. That I am aulhorized by the owner of lhis property to perform the wo�lc for which application is made and I comply wiM the <br />State Conkactors Law 18.27 RCW and 296.200 WAC. <br />