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P�.RMIT APPLICATI(��V <br />CITY OF EVERETT P►_RMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />?03�' <br />LEGA LOT NO. <br />BLOCK <br />TRACT <br />PARCEL TAX I.D. # <br />� <br />� <br />EJZ92//2�� � � %/Fl.� ���� /06 r��� J� L � 7 �)r37 / ���5 / <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />/���� � ' �' . I �o ��i�� �t %Tr`� �i2��-�'�� /�'6'`���_' :' <br />CONTRACTOR /y /� S � <br />�U��/, � � it . � <br />CONTR.LI6ERSE# /„'��/.�/. �!,'��:C <br />y� � (Y <br />USE OF BUILDING <br />Ci�/�i,�GG <br />WORK DESCRIPTION <br />p�.c lc�o �'�1�Z <br />ADDRESS <br />?/�a .�x /�9�1-� �� <br />. • <br />CITY2IP PHONE � <br />b `,�1'f2�v� Y2d"_Zi 5'-%L�o <br />�� c. ' , <br />— HEAT SOURCE I CONTRACT PRICE OF WORK <br />Electnc Gas Other { �� �7 —��, pC�iJ <br />�'.�-.z,�e � ��z o � p,� s � �f'. G S - � / /S�o 9/' <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />8ackflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — 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 />Exhaust fan <br />Heat pump <br />Unit heater <br />Bailer <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 7105 <br />I hereby ceritify that I have read and examined lhis applicalion and know the same to be true and cnrrect. AII provicions of laws and <br />ordinaces goveming this type of work will be complied wilh 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 regulating construcUnn or the parform� ;ce 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 />Slate Contractors Law 18.27 RCW and 296.200 WAC. <br />/J /� �� / -, . / <br />�IL <br />