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PE�MIT APPLICATION <br />CITY OF EVERETi 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 PARCEL TAX I.D. # <br />I�l 1 uIC�L.�IiJI� I Oo�34�-93Q�-Lo��Soo <br />L[GAL LOTNO. BLOCK TRACT <br />DESC. <br />�2c�ocz-1 I�, srn�-�! �g�� v�0.4„��A <br />TENANTNAM[ CONTACTFORPERMIT <br />SAME I SPrnE <br />CONTRACTOR ADDRESS <br />`�T�-cL RpoF' ��-l� ,11�1C . `�' 1 �.L . �CE.I.S�-{ <br />CONTR. LICENS[ # <br />STATCf� 10 \ S�,V <br />USE OF BUILDING <br />HEATSOURCE <br />_ [Icdric _ Gas _ Olher <br /># <br />1.11�IL1Y Y1IVIVC A�f�� <br />-T�- <br />�tc�2� q�o� �.52,-�e <br />PHONE `�� <br />SP.ME n'lq�..�:i. <br />CINIZIP PHONE �,—pjp�� <br />Mc��C -4�1�-`11e4 <br />q431.."l2 <br />WORK DESCRIPTION <br />(�mo.tE A�� E�.P�..acL ex�5-T��t� �r.c� <br />�ER ��r•,cNEp D�.+.Ut�.MC.S� P��-K <br />STAiRS <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washcr <br />Laundry lray <br />Sink (s�rvicelbadmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />CONTRACT PRICE OP WORK <br />5''1o"lt�. Q,O <br />�R.c.H lD��� <br />� `��ulz' <br />= 4' x �,5' <br />N0. I NPE OF FI%TURE OR ITEM <br />A/C — air handling unils <br />Forced air syslems <br />Gas piping <br />Waten c�aler <br />Gas fireplace <br />Gas rangc <br />Clothes dryer <br />Range hood <br />Exliausl fan <br />Heat pump <br />Unil heater <br />Boiler <br />Refric�eration <br />Woodstove <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby cerili(y that I have read and examined this application and know Ihe same to be true and wrrecl. All provisions of laws a,id <br />ordinaces goveming �his type of work will be complied wilh �vhetl�er specified here�n or noL The granling of a permit does nol presume <br />to give au�horiry lo violate or cancel Uie provision o( any olher slale or local law rcgulaling consWc�ion or lhe perfortnance of <br />construc"on. That I am aulhorized by lhe avner of Ihis property to pedorm Ihe work for which application is made and I comply with the <br />Stale ConUactors Law 18.27 RCW and 296r200 WAC. <br />'/a <br />