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P�RMIT APPLICATION <br />CITY OF EVERETI' PERMIT SERVICES <br />3200 CEDAR STRE�T, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # (P�E�R.M�I�T X <br />I.�„��' �, ''!i. � ' � ' %. • ����Cj �C� ��?Cj l{ 1 ' `-.'i'"I I I -� <br />LEGA lOTNO., BLOCK�i �.i TRACT <br />r., � <br />DESC.1'"��,�-it-�, r-1_.1G:. Y �:.� � -11.'C-.4�h�:�• �.../,.al��' �'.�,�11 <br />�!rlcy t.'. nf.t_,%i'•-���'-,' r� � �:•r , i '(� . . <br />_.....__ , .....ocec� GTV21P FMONE <br />t <br />i <br />TENANTNAME <br />CONTRACTOR � ` % I��y� <br />�,lW <br />CONTR. LICENSE il <br />USE OF BUILDING <br />i�� , . <br />' �' <br />WORK DESCRIPTION <br />f�.. ' ' ( �� 1 � <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Cbthes washer <br />Laundry tray <br />Sink (service/bar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CONTACT FOR PERMIT , .� , <br />. 1-I . . i. , . � <br />,- . ._r ., ' � <br />ADDRESS CITY2IP <br />� <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />i l . �:. Y� . ��� _i��..i'.,� . <br />,. . 1 � r- r�"L�. f'�•'•. `- <br />PMONE <br />Z52-3(0 <br />PHON�/ <br />/ 1 <br />CONTRACT PRICE OF WORK <br />��.���[�c� <br />� � <br />Np, I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater � =. <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woadstove <br />Other <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />II hereby ceritity lhat I have read and examined lhis apptication and know the same to be true and correct. All provisions of laws and <br />� ordinaces goveming this type of work will be complied with whether specified herein or not. The granting o( a permil does nol presume <br />to give authonry lo violale or cancel the provision of any other state or local Iaw regulating construction or the perlortnance of <br />�� construction. That I am authorized by the owner o( lhis pmperty to perform the work for which application is made and I wmply with the <br />' State Cont�ctors Law 18.27 RCW and 296.200 WAC. <br />.�.L( � <br />yDate � <br />Z <br />