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rERMiT APPLICAI �ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org J <br />P� � -/s .. <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />ia�ai n%� <br />LEGA LOT N0. <br />PARCEL TAX I.D. # <br />-no1-011 - <br />s—�� _ ,,� <br />BLOCK TRACT L�7V p��,'V�X�T: SfY ��Z-�—c3 <br />-7 R�4NcNu 1i�rE�x.c�,—�/ �iu,sioi✓ +bz- , U �3 , P3z <br />4L5 <br />L✓��ce��r�o I�vNES 1��, ��, r3�X �yb Lk. s-r�vtri b ti�zs� 3sc--+��7 <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />SrcuE wwrc8�5 yzs- aS c��%G 7 <br />CONTRACTOR LH,�ELfln� Iivrw�,s �•G!�DRESS CITY2IP PHONE <br />CONTR. LICENSE # L.l4 K C, C NI 00 J,rL <br />USE OF BUILDING <br />� G �. <br />WORK DESCRIPTION <br />NO. � TYPE OF FIXTURE OR ITEM <br />3 Toilet <br />3 Balhtub <br />� Lavatory (wash basin) <br />Shower <br />I Kitchen sink & disposal <br />I Dishwasher <br />I Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Llrinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ Electric � Gas _ Other <br />[�Zt Gc�^ C. <br />NO. I <br />CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heatpump <br />UNt heater <br />Boiler <br />Refigeration <br />Woadstove <br />C�TY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby ceritify that I have read and examined this applicatlon and know the same to be true and correct. All provisions of laws and <br />ordinaces g�verning this rype of work will be complied with whether specified herein or not. The granting of a pertnit does not presune <br />to give authonry to violato or cancel the provision of any other state or local law regulaUng consWction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which applicallon is made and I comply with the <br />State Contractors Law 1U.27 RCW and 296.200 WAC. <br />�-� . �,.��_SL__� ZIsl�s <br />� <br />h <br />� <br />