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P�RMIT APPLICATI(..N <br />CITY OF EVERETT PERMIT SERVICES ����v� 33 <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org � � <br />ca sc � �� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACGEPTED <br />SITE ADDRESS <br />3oio ln� ��2��-' vi= w �/Z <br />IEGAL LOTNO. BLOCK <br />DESC. �o72G S• � � x �.2 Z <br />TENANT N�E <br />�ili �)'L <br />CONTRACTOR UwN? <br />CONTR. LICENSE # <br />L�SE OF BUILDING <br />/.i.� 5 � � z-,v T/A L <br />WORK DESCRIPTION <br />PARCEL TAX I.D. q PERMIT # <br />3�5- �,22-o2G-��i 0.5U/,3! <br />TRACT <br />�ONTACTFORPERMIT <br />iS /-/ALL ; r <br />�j�. iu%=� ADDRESS <br />; ��%i�c� �f�����`� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Cbthes washer <br />Laundry tray <br />Sink (servicelbar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Clher <br />_�---��p� UlA �'1 d6= <br />PHONE <br />.�z���� - ��� <br />�l�rz �/,�� -5v� • �soo <br />CITYIZIP PHONE <br />��,/`n_ �i /1roV� <br />HEATSOURCE <br />i� <br />� Electnc _ Gas _ Other <br />CONTRAC? PRICE OF WORK <br />��X)� U�X� � aC� <br />���-�� 99.�Z �,h <br />N0. I IYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />W ater heater <br />Gas freplace <br />Gas range <br />Cloihes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3�05 <br />I hereby ceritify that I have read and examined this applica:ion and know the same to be true and correct. All provisions ot Iaws and <br />ordinaces governing this type of work will be camplied with whether specified herein or noL The granting of a permit does not presume <br />to give authonty to violate or cancel lhe provisioa of any other state or local law regulating construction or the peRormance of <br />construction. That I am aulhoriz b�the owner o'this property to perfcrm the work for �vhich application is made and I comply with the <br />Slate Contractors Law:78�27��1N and 290.200 W AC. <br />r��� -«'__ �, z� ' �S� I <br />Signature of OwneriContractor/Authonzed Agent �dte f 2 <br />� <br />,� f; .�'zyJ <br />