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SITE <br />P�RMIT APPLICATIC,N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-3810 — FAX 425-257-8857 — www.everettwa.org <br />�l.J S D I - � c�/ <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />ti <br />mo��'�'A RD <br />�O. ii' BLOCK <br />I�a�k (3�c� . ccv.�T <br />TENANTNAME <br />CONTRACTOR <br />Uqqc1� 13P_oS, Cc�NST <br />CONTR. LICENSE S <br />�� ��ck �3 zo � a <br />USE OF BUILDiNG <br />�v�P�EX <br />WORK DESCRIPTION <br />N�w <br />PARCEL TAX I.D. # PERMIT A <br />OoSS��foo6olaol C ��i�13 <br />�A�T �sP v3-oi� <br />2 ��-t�, � <br />A�DRESS CITY2IP PHONE <br />39aa 6'rtrq�_tiE �y,,eaer�r `�05 112�-3G'7-736b <br />CONTACT FOR PE MIT <br />�e1 HAc�,C <br />ADDRESS <br />3�►aa �--r�A� �,E <br />PHONE <br />�izs�a�+�-a�aq <br />CITY/ZIP PHONE <br />E�c-ee ;t 962oS �ZS 3�1�-1360 <br />HEATSOURCE <br />Electric � Gas _ Other <br />-� � v <br />��p�cx d���� <br />� �� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />LaunAry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />� Z� O'` � i-1,�- r�� <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 />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. Ail provisions of laws and <br />ordinaces governing this type of work will be complied wilh whelher 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 construction or the perfortnance of <br />�onstruction. 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 />�� Contr ct s Law 18.27 RCW and 29�200 WAC. <br />-� �' �l'�i <br />��y� � <br />