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P�r2MIT APPLICATICr�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETr, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEP?ED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />5� 3, or�K's ���-� rb5c�-ac3 <br />LOTNO. � BLOCK � TRACT <br />����C%� �� .t 1 K- ��FC�jO : lZ �l ° S� — <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />CONTRACTOR t7l'7N 5/-�� `" �a h� r1 `� ADDRESS y j�0 /`/(�fh S/swCl7YlzIP PHONE S/z!—. ��/G��37(� <br />CONTR.LiCENSE#.L7J�J(,�/�� �f�Q3�� <br />USE OF BUILDING <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />L Y/o'4/c.+oe� <br />WORK DESCRIPTION ��/�� f� �= ��a �`� 2 /+��T"d ���� S�d F" n`� i y <br />� O <br />/NSTi��I LieiC�`% /'��2 T 1LTTi �M� Lh7�:�.�c�h4l2y /J <br />NO. I TYPE OF FIXTURE OR ITEM <br />Tai�el <br />Lavatory (wash basin) <br />Shcwar <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WOfiK <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC — air handling units <br />For ed air systems <br />Gas piping <br />V.'aier heater <br />Gas fireplace <br />Gas range <br />Clathes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SAlES TAX CODE IS 3'105 <br />I hereby ceritify that I have read and ezamined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work �vill be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authonty lo violate or cancel ,he provision of any other state or local law reaulating construction or the performance of <br />construction. That I am authon ed by the owner of this property to perform the work for �vhich application is made and I comply with lhe <br />State Contractorslaw 18. . CW and 2� AC. <br />L�� —���/ 11 �-a ���—.c�S' <br />