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PERMIT APPLICATIOnI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA P9201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIOki ARE ACCEPTED FROM 8 AM TO 4 PM ���;���)� -O� � <br />SITE ADDRESS PARCEL TAX I.D. # <br />ols3o cJG/Hkt st a9 os.�v ooy o�s o0 <br />LOT N0. I BLOCK I TRACT <br />�G7i'��i c�{n;%a �ia.00 /90?// 89f� A�� NE fJ�l;,sfa., 982.?3 ,�'ao 43S-�o�5 <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />itlA I /�n�in �ra�o 3Go� v3s-�ov5 <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />�4� n tr <br />CONTR. LICENSE il <br />.UOTAQG'@j 99S'RF /9.?// Slft �4c .dC fJ�/.�yfo., �✓H`r'�ruj3GU-435�'7G�S <br />USE OF BUILDING <br />SF� <br />WORK DESnCRIP' <br />/��o( On <br />exrs�,�;s �, <br />, <br />� � e�,o.. � <br />NO. I <br />� <br />a sto�y Gd�P,�� <br />� rcroo'F" Cis�•�s <br />TYPE OF FIXTURE OR ITEM <br />Toilel <br />6alhtub i <br />Lavalory (wash basin) !; <br />Shower <br />Kitchen sink 8 disposal <br />Di�hwasher <br />Clothes washer <br />Waler healer <br />Sink (service/badmop/etc.) <br />Back(low preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />HEATSOURCE <br />Electric Gas <br />� � <br />u.. ��.,y9� / � <br />feqr <br />CONTRACT PRICE OF WORK <br />PXi3�'^5 w,�.�do - � I'CS�d'L <br />�` �u�v%ill�5c� <br />NO. I TYPE OF FIXTURE OR <br />A/C - air handling units <br />Forced air systems <br />Gas pipiny � V <br />Waler he�ater ���� l �' � <br />Gas fireplace . � <br />Gas ran e � � <br />Clothes dryer ,�1 �,� <br />Ranye hood _ ^,r <br />Exhausl(an :I� ���il <br />Heal pump � <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstovo <br />Olher <br />CITY OF EVERETT LOCAL SALES TA7( CODE IS 3105 <br />1 hereby ceritify that I have read and examined Ihis applicalion and know lhe samo lo be lrue and correcL All provisions of laws and <br />ordinaces goveming Ihis lype ol work will be complied with whelher speci(ied herein or noL The granting of a pormit doos not presume <br />lo give aulhority to violate or cancel lhe provision of any other slale or local law regulaling consiruction or lhe pedormance of <br />conslruction. That I am aulhorized by the owner of this property lo peAorm the work for which application is made and I comply with the <br />State Conlraclors Law 18.27 RCW and 2�J6.200 WAC. <br />/2- <br />