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SITE ADDRESS <br />15�o JC <br />LEGAL LOTNO. <br />DESC. <br />C t�, �. nJ. �_c <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDA�? STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM s AM TO 4 PM <br />9LOCK <br />PARCEL TAX I.D. # <br />� --/ S� /� <br />PERMIT i! <br />TENANTNAME (� l � CONTACTFORPERMIT PHONE <br />�vu. c�l ��K �% RCf'1 �) P�� I i 1"I� r1 �C I � d.y 9',-, -�C-v `/r1 SI `%.3� �, <br />CONTRACTOR`, ADDRE55 CITYZP PHONE <br />G�-5 1�T�t�H,.� �i-�,'l�,�j :'$7� ��-�ln �, n1��.u•� ,��a 7� 3L-�� -7Yy_7�E <br />CONTR. LICENSE # _ <br />UnSE OF BUILDING <br />rl���i)� <br />WORK DEJSCRIPTION)/ <br />Tiil:s I1x � ) T{ <br />� T� i��-g `�v�..A <br />HEATSOURCE <br />Electric � Gas _ Other <br />T�S�I"�P �j w� �li /� <br />��.�- �tib�,,. <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />BalhWb <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry lray <br />Sink (service/barlmop/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 />30, �5a_ '� <br />C �M�� T}Jn yc�S K rj �Y. c`i� �y� 3 Q� <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling uNu <br />Forced air systems <br />Gas pipir�g <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Euhaustfan <br />Heat pump <br />Unit healer <br />Boiler <br />Retrigeration <br />Woodslove <br />Olher <br />CITY Of EVERETT LOCAL SALES TAX COOE IS 3105 <br />I hereby ceritiry that I tiave read and examin�d this application 2nd know th2 Sam? to be tNA 8Ad CORQCf. All p�OVISI011S 0(12WS 211d <br />ordinaces governing this type of work will be complied with whether specifed harein or not. The grenting of a permit does not presume <br />to give authority to violate or c3ncel lhe provision of any other state or local law regulating construdion or the perfortnance of <br />construction. That I am authorized by the owner of lhis property lo perform the wo!k for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.20� WAC. <br />'/a <br />