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PcRMIT APPLICATIGnI <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 />SITE ADDRESS <br />/�'�.jn yri, ,��,�. ��-; <br />LEGAL LOT NO. BLOCK <br />:SC��C7�� <br />TENANTNAME <br />CONTRACTOR <br />f y/,-�.�:; <br />CONTR. LICENSE <br />PARCEL TAX I.D. # <br />TRACT <br /># <br />� �., % /�'�.2i0 �/�, �,� GC,� Fur. t-IT �j87�,y '�zs-5 /3-� c�s: <br />CONTACTFORPERMIT PHONE <br />s�����. r,r�„�s Uz> -303-���`r7 <br />ADDRESS CITYIZIP PHONE <br />5� /rs �! Sr.v,�C 3E �'/ � vr..t%/;�_c �=t..'�2� <br />��L� _ z-� i- z i�/ <br />- S-�;atif�so�i2�� z Is�z�' � <br />USE OF BUILDING <br />.5�+ ) i <br />✓l .�7%,s�s7�:.� -. � v�'i. <br />HEATSOURCE <br />Electric � Gas <br />WORK DESCRIPTION J <br />��_�� �'� L�-:� ��v- /yh /� <br />NO. I TYPE OF FIXTUR[ OR ITEM <br />Toilet <br />Dathtub <br />Lavatory (wash basin) <br />Shawer <br />Kilclien sink & disposal <br />Dishwasher <br />Clolhes washer <br />� Walerhea�er <br />Sink (service/har/mop/etc.) <br />Dackllow preventer <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grease irap <br />Rool drains <br />Olher <br />CCU <br />CONTRACT PRICE OF WORK <br />Other �/ ��� `�— <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air syslems <br />Gas pipinc� <br />Water heater <br />Gas fireplace <br />Gas ranc�e <br />Clothes drycr <br />Range hoou <br />Exhausl (an <br />lieal pump <br />Unit heater <br />Boiler <br />Refrigera�ion <br />Woodstove <br />CIN OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this application and know the same to bo true and cortect. All provisions of laws and <br />ordinaces c�overning this typo of work �aiil be complied with whelher specified herein or not. Tho grantin� o( a permit doos not presume <br />to give aulhority to violale or cancel the provision of :�ny olher state or local I�w regulating conslructicn or lhe pertormance of <br />conslruclion. Thal I am aulhorized by tho owner o( Ihis propeAy to perlorm lhe work tor which appiication is made and I comply wilh the <br />State Contraclors Law 1N.27 RCW and 296.200 WAC. � <br />�--= / f//..-i .i�';�—_ �//C'� � <br />