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�cRMIT APPLICATIuN G���-0S <br />CITY OF EVERETT PEr2MIT 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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />��7�I S C'u I�vrs�- ,�vL <br />LEGA LOT NO. BLOCK <br />TENANTNAME <br />PAP.CEL TAX I.D. # <br />,1`+ 0 y36 ce3o66o0 <br />TRACT <br />,5,�' 29-OI <br />/�'ls /77t�' <br />p <br />�/-.� �Y - oy/o <br />CONTACT FOR PERMIT PHONE <br />�� • <br />�es� (�voS�� �i2s-o��21-�10 . . <br />CONTRACTOR 7"'` ADDRESS � <br />�telAl+� �linS�V✓c���(,1n ,-Yv��w �g�s �7�tii-�iG %�� <br />CONTR. LICENSE # _ ' <br />USE OF BUILDING <br />F2 <br />WORK DESCRIPTION <br />HEATSOURCE <br />Electric �Gas _ Other <br />J' /-(it� ��(-Viv-/ <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet � <br />Balhlub � <br />Lavalory (wash basin) � . <br />Shower i <br />Kitchen sink 8 disposal . <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (servicelbadmop/etc.) <br />Back(low prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Greasr, trap <br />Roof drains <br />Olher <br />CITY/ZIP PHONE <br />i�/�J�"'�C� . j13��.Cil� . <br />y-�la' v'�IU <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping � <br />Water heater <br />Gas fireplace <br />Gas range <br />Cbthes dryer <br />Range hood i <br />Exhauslfan J�/ <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />� <br />I hereby ceriti(y that I have read and examined this application and kno�v the same to be true and cortect. All provisiuns of laws and <br />ordinaces govemirg Ihis lype of work will be complied with whether specifed herain or noL The granting of a permil does not presume <br />to give authority to violate or cancel tho provision of any other state or local law re9ulating consWcGon o� "�e performance of <br />construction.'fhat I am aulho�ized by the owner of this property to peAorm lhe work for which applir,ation is made and I comply with Ihe <br />Sfate ConUactors Law 18.27 RC'N and 296.200 WAC. <br />5 =,� `1- C.S� <br />