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P�,ZMIT APPLICATIO�d <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-25'�'-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS /_J/ //J PARCEL TAX I.D. # FERMIT � <br />��%�� //O/� •'�O— � UOSSZ`�� (7.y-i-o/1 -OJ I L/ S ��-�� <br />LEGA LOT N0. BLOCK TRACT C� i y p� ��1CG i' ,S kI �'h: Z� 1-� j <br />DESC. cS � �Ayu/a Ti, ,-�� i� E�, �. !� Z, U!3 ,�°3 z <br />LnkEL/�n9 �%n7cS Tnc, �•u. $oX �V� <br />TENANTNAME CONTAC7FORPERMIT <br />� �-r�,u� <br />CONTRACTOR ������ ADDRESS <br />� i�0 �7+� S J-Nc . <br />CONTR. LICENSE 11 (_yQkL �Z' �� ��'L <br />USE OF BUILDING <br />�r+Z 2dg(, � <br />WORK DESCRIPTION <br />3 <br />NO. I TYPE OF FIXTURE OR ITEM <br />8 Toilet <br />,% �S Bathtub <br />� Lavalory (wash basin) <br />� Shower <br />�Kitchen sink 8 disposal <br />Dishwasher <br />,� Clothes washer <br />Laundry tray <br />Sink (service/bar/mopletc.) <br />Backflow preventer <br />Urinal <br />_ Drinking Fountain <br />' Floor drain <br />Grease trap <br />Roof drains <br />Other <br />G+�-. STcUchs <br />lu1'�✓L�� 5 <br />CIN21P <br />HEAT SOURCE <br />_ Electric �Gas <br />Other <br />�g�5 <� <br />� <br />PHONE <br />�/zs- 3S� - � 7G 7 <br />PHONE <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handiing units <br />Forced afr systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas renge <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 5703 <br />I hereby ceritify that I have read and examined this applicatlon and know the same to 6e true and cortect. All provis(ons of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authonty to violate or cancel the provision of any other state or local law regulaUng construcdon or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />��— W w�, Z/� lo S <br />Signature of OwnedContrecronAulhonzed Agent ate �I,y <br />