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PERIVIIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />�-'�0�, /ti��/Kl �fPO C'`>I�C1 y <br />LEGAL LOTNO.J ef BLOCK <br />DESC. SP..F L-of� �- O�o <br />T,rFc� �„i7 <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />L <br />USE OF BUILDING <br />/�CS�rI�I'.1{'r!. � Lc <br />PARCEL TAX I.D. # <br />;o�_ �o��oo �o <br />TRACT <br />Ff� /�..f��P %P/ l�i <br />nooRess <br />) ���J:Ih��t� gl✓=( <br />COHTACTFORPERMIT <br />����� S,.u<t�._ <br />ADDRESS <br />Sec. 36,T <br />E�,�-�.+- ,v,( <br />AIT 8 <br />S/0 - <br />yJS a68 -26.��.2 <br />df-3�3-3038 <br />PHONE <br />�as-ac;s_?�� <br />CITY2IP PHONE <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ i <br />�iectric _ Gas _ Other <br />WORK DESCRIPTION - - <br />—5���+-,�1 �ns F+qrh9��e /nc(w�,n� 9`.5 /.�y�i�l7 . <br />�1 <br />�-Y2-Q1oc�:,p��.�t-NOII ���1 �ti.r�f-P��P.��ei� i��I��;���s����� <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />_ Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service�bar/mop/etc.) <br />^ BackBow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />rVC - air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas firepiace <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 />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritity th2t I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces yoverning this type of work will be complied with whether specified herein or net. The granting of a pertnit does nol pr=sume <br />to give authority to violate or cancel lhe provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner ot this property to pertorm the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 290"200 WAC. <br />�.. ... . � %G/S'/�-- <br />