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i� <br />P�rtMIT A�PLIGATIO�� <br />CITY OF EVERETT PERMIT SERVIC�S � <br />3200 CEDAR STREET, �VERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org � <br />�saa-� <br />APPLI::ATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTEO <br />SITE ADDRESS <br />/o i � S <br />LOT N0� <br />E.�il[ t �/an O <br />� <br />, PARCEL TAX I.D. # PERMIT # � <br />,,� ��L. oaSsz�1- oo� - a� -oc� � S�� `/5 <br />e�ocK Tancr U•-1c� ��� i:uc-t�`7-r j� !1 �z.: �-+-o? <br />7 i�-<1i��No .Z)7irnU�� �,Jl$�pl-� Z, U 13 . i�32 <br />l%n1L'.S Z��c. ��o. �jx ?�d8 C.�� S'T�.✓Fy7S' %�LSg <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />S�T�U� l�.)N�2..�15 ���S�3S� i7G7 <br />CONTRACTORL���tC/��r70 ��IoN��I TNL• '0'�DRESS CITY2IP PHONE <br />CONTR. LICENSE N G�l I�C LN l GJ I fL <br />USE OF BUILDING <br />S �-�` 2`��. � <br />W'ORK DESCRIPTION <br />C� <br />NO. � TYPE OF FI�'TURE OR ITEM <br />Toilet <br />Bathtub <br />l),' Lavatory (wash basin) <br />'T Shower <br />� Kitchen sink 8 disposal <br />�_ Dishwasher <br />,� Clothes washer <br />Laundry tray <br />Sink (service/badmop/etcJ <br />Backflow preventer <br />Urinal <br />Ddnking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ Electric � �as _ Other <br />//��1��� <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF PIXTURE 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 />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J103 <br />I hereby ceritify that I have read and examined this applicatlon and know the same to be true and cortect. All provisions of laws and <br />ordinaces governing this rype of work will be complied with whether specified herein or not. The grantlng of a pertnit does not presume <br />to give authority to violate or cancel the provision of any other state or local law reguladng construcUon or the pertortnance 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�NAC. � <br />v ��.� <br />y� <br />