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PE.2MIT APPLICATIO�J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 /_ a� �P�.S� <br />425-257-8810 - FAX 425-257-8357 - www.everettwa.org <br />�� SZ� � oo� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CAR^S ARE NOT ACCEPTED <br />SITE AD�DRpESS 2��F� PARCEL TAX I.D. # �� U� ���0� �"� /PE�RMIT # <br />�a-e hl.J I C�� �� 7� 1 V i� �L � r.� �; �d C� � C7� `�%' �� <br />LJT NO. _ I BLOCK I TRACT <br />�(-CU[�'� �Ui1r7'IINc �v�U/l �1/V�i � 01 J <br />TENANTNAME <br />CONTRACTOR <br />(�, �it�n ��,� sl�,.�,�,/�.i �i„uC , <br />CONTR. LICENSE # <br />USE OF BUILDING <br />5 r �z <br />WORK DESCRIPTION <br />��� <br />NO. I TYPE OF FUCTURE OR ITEM <br />3 Toilet <br />� Balhtub <br />t. Lavatory (wash basin) <br />I Shawer <br />�_ Kitchen sink 8 disposal <br />� Dishwasher <br />_L Clolhes washer <br />�_ Laundry tray <br />�� Sink (service/bar/mop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />�. /� �.7 'IJ�J % <br />,.�, „��� , ,,., � 4.L5'-�! <br />L <br />17�i/}vE �v�= s��i�-lr's w�t�98� <br />CONiACT FOR PERMIT <br />ADDRESS ,�.� <br />/KrS ��� /�-Vi:'. <br />HEATSOURCE <br />_ Electnc �Gas _ Other <br />PHONE <br />CITY2IP P ONE <br />,v� ��d, �,�s v�zyo <br />L/Zs�2/ b' o �//� <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A1C — air handling units <br />Forced air systems <br />Gas pipin� <br />Water haater <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 />Woadstove <br />CI7Y OF EVERETT LOCAL SALES SAX CODE IS �105 <br />I hereby ceritify that I have read and examined this application and kno�v the same ro be true and correct. All provisions of laws and <br />ordinaces goveming Ihis rype of work will be complied wiih whether specified herein or noL The granting of a permit does not presume <br />' to give authonty to violate or cancel the provision of any other state or local taw regulating construction or the performance of <br />construction. That I am authorized by the owner of this property ;o pertorm the �vork for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Z-ZY'� <br />� �� <br />