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SITE ADDRESS <br />LEGAL LOT;aO. <br />oEs�. 3 <br />PERMIT APPLICATION <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />ssr¢��iQoi <br />BLOCK TRACT OR SUBDIVISION # <br />n� �v.A s��c ��v 3 <br />�RMIT # <br />� (111�'W�1 <br />VYYIYCR <br />Szz �or p� <br />E'io-,e SrE�.v.���sE'l��' 5...�,-�2m- ED�dS`�2o ao�•9�99•6z9z <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />� E•MAIL <br />CONTRACTOR ADDRESS C TY21 P O E <br />R�u�i ,�.���r ��cs:. /�.c, �aosC 3sy -�,�vAe.tS'�°�% <br />CONTR. LICENSE # <br />i3 �uErLer 98 <br />USE OF BUILDING <br />S�'�- <br />WORK DESCRIPTION <br />�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balh�ub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Cishwasher <br />Clolhes �vasher <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Irap <br />Roof drains <br />Other <br />HEAT SOURCE <br />� Electric _ Gas _ Other <br />- - �^ <br />����� <br />NO. I <br />Y'� <br />CONTRACT PRICE OF WORK <br />� ��"�, ZCY��' <br />��A�t�� <br />� <br />TYPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas freplace <br />Gas range <br />C�othes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerlify that I have read and examined lhis applicalion and know ihe same to be irue and correcL Ali provisions of laws and <br />ordinances governing lhis lype of work will be complied wilh whether specified herein or nol. The granling of a permit does not presume <br />to give authoriry b vi(� ale or cancel the provision of any other slate or local law regulaling construclion or lhe peAormance of <br />consiruction. Thal IG�hori�by ihe wner of ihis property to perform lhe work for which appliwtion is made and I comply with the <br />Stale Conlractors La� 827 a 200 WAC. <br />� � �o •/3•/c� <br />Signature of OwnedContraclodAuthorized Agent Date �/a <br />