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P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FNX 425-257-8857 — www.everettwa.org <br />SITE ADDRESS <br />�' `✓' � 1 <br />I FGAL LOT NO. <br />� �� 5oh���� <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE N <br />� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM _ <br />e <br />, <br />BLOCK <br />PARCEL TAX I.D. # <br />�pti8�z��0o�2� i <br />C% l ' <br />DS-�'-� <br />18�� GY,�� S�i. V,,; <br />CONTACT FOR PERMIT <br />K� =}�„ � �y� � :. :. �3���;6: <br />ADORESS CITYIZIP PHONE <br />..� _� D� �� � <br />j2_i6-o5 <br />'�RMIT # <br />� S�/� '��'S <br />M 3�v0 <br />�•��Jv.ItY,c✓A �s9 <br />PHONE <br />DP,�o�-ICZ � Dy��� <br />USE OF BUILDING <br />S �- 2 <br />WORK DESCRIPTION <br />Np, I TYPE OI' FIXTURE OR ITEM <br />2 Toilel <br />2 Balhtub <br />� Lavalory (wash basin) <br />I Sliawer <br />� Kitchen sink 8 disposal <br />1 Dishwasher <br />� Clolhes washer <br />'7� Walerhealer <br />� Sink (service��ar/mopletc.) <br />Back(low preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />�Rooi drains <br />Other <br />HEATSOURCE <br />Electric �Gas _ Other <br />13 `i � � `° � ` � <br />� <br />. <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />T Forced air syslems <br />� Gas pipinc� <br />/ Waterhealer <br />Gas fireplace <br />1 Gas range <br />l Clothes dryer <br />1 Range hood <br />�i Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SAlES TAX CODE IS J105 <br />I hereby cerilify lhal I have read and examined lhis applicalion and know the same lo be lrue and correcL All provisions of laws and <br />ordinaces goveming Ihis lype of work will be complied with whether specified herein or noL The granting of a permit does not presume <br />to give authoriry to violale or cancel the provision o( any olher state or local law regulating construction er tha peAormance of <br />conslruclion. That I am aulhorized b-Me owner of this property lo pedorm the work tor which application is made and I compty %�h th/� <br />Stale CnNractors La�v ��r�e.27 R and 296200 WAC. C/ <br />/ IZ�f ,�/ �3�d <br />Signature of Ow �t / ntractodAuthorized Agent Date <br />0 � <br />-i�7� n C7� <br />