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P�RMIT APPLICATI(�N <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 />8- 5-os <br />APPLICATIONS ARE ACCEPTED FROM b AM TO 4 PM - DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />�, ao _ t � � <br />LEGA LOTNO. <br />DESC. <br />� <br />OWNER � � <br />�� <br />k�ssM��� 3a�� <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # N/�} <br />USE OF BUILDING <br />Vi�-w A2�A ��CG <br />WORK 6ESCRIPTION <br />NO. <br />PARCEL TAX I.D. # <br />o !3 �I . 005-7 I % 00 <br />BLOCK TRACT <br />TYPE OF FIXTURE OR ITEM <br />Tailet <br />Bathtub <br />Lavatory (.wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />�rinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Other <br />CONiACT FOF PERMIT <br />PERMIT # <br />� <br />yas - 3�I "J -5 <br />'L N 7�5-77,7-5a <br />PHONE <br />162��r K�sSMal-� �/.�s -3N"7-�a7� <br />ADDRESS CIN21P PHONE <br />��pQ yzS-316-3Jy3 <br />�.s� UlG _�]�iL/—],C/ 't <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric _ Gas _ Other ��. ��n <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Ciothes dryer <br />Range hood <br />cxhaustfan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrige2tion <br />Waodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3�05 <br />I hereby ceriti(y that I have read and examined lhis application and know the same to be true and correct. All provision� -'!aws and <br />I ordinaces goveming this rype of work will be complied wiih whether specified herein or not. The grantirg of a permit dc s not presume <br />� to give authonty to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That/� am authorized by the owner o( this property ;o perform the work for which application is made and I comply wilh lhe <br />� �le�ontrac�rs�Law 1827 RCW and 296.200 WAC. <br />! IJ / <br />1'2 <br />