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P'�RMIT APPLICATI��� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wuvw.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS I PARCEL TAX I.D. N RERNIT • <br />�%G3s�/JlOK'C-t�J �d I �o3y33aao�//�-oe- � Q� �-Da <br />LEGA LOTNO. �� BLOCK TRACT r <br />DESC.r ��� <br />OWNER <br />F= 7� � � cE <br />TENANTNAME <br />N�� <br />CONTRACTOR �/�� <br />CONTR. LICENSE it <br />USE OF BUILDING <br />//tR(CRJ/� <br />WORK DESCRIPTION <br />/.��-� .L.1��u.J <br />e.e � � �J <br />C /iie�0.� / <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 />Cbthes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trep <br />Roof drains <br />Other <br />'!3/ /06'—` 1 <br />CONTACT FOR PERMIT <br />HEATSOURCE <br />�Electric _ Gas _ Other <br />� �9.PT//- S � <br />CITY2IP PHONE <br />�r/ `f8'1s8� �/•'t <br />PHONE <br />T <br />CITY2IP PNOME <br />� 33� �is7 <br />CONTRACT PRICE OF WORK <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C - air handling u;ifts <br />Forced afr systems <br />Gas piping <br />Y�ater heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />I hareby ceritify that I have read and examined this application and know the same to be true and correct. All provfsions of laws and <br />ordinaces goveming this type of work will be complied wilh whether specified herefn or not. The grantlng of a pertnit does not presume <br />to give aulhority to violate or cancel lhe provision of any other state or local law regulating construcBon or the perfortnance of <br />construction. That I am authorized by the owner of this property to perform lhe work for which application is made and I comply with the <br />State Conlractors Law 18.27 RCW and 296.200 WAC. <br />Signature of OwnedContraccorlAuthorized Agent ate <br />