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SITE ADDRESS <br />LOT NO. <br />DESC. <br />�ERMIT ARPLICAT�N <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 />�'b/6 P4c�i=.L <br />BLOCK TRACT <br />�//1�51 �a�.'75Y �Mv2t-�/ �L�/�+ <br />PARCEL TAX I.D. # <br />paz�,=�� <br />TENANT NAME CONTACT FOR PERMIT <br />� /L�ii /g-4-Pn s; 14�v /7.�g. � s ��,.i <br />CONTRACTOR ADDRESS <br />/u7.g�NSc'.✓ /Jii�l.�. �..-c.. �2��33U �21�rn/ .Q�cf <br />CONTR. LICENSE N �v�= <br />�-Di3/n./�'� L7L L'j� <br />USE OF BUILDING <br />C �F ✓/! t �:/ <br />WORK DESCRIPTION <br />�� v,»/3��--v �viL <br />s_ '�-Ob <br />PE T M <br />PHONE <br />�z s ZS f 9j6� <br />PHONE <br />,3G[J Yn3 "JYbL <br />CITY2IP PHONE <br />n�L�.,.-Grd� 3(,v ya3 �v6 7 <br />Q�'1z j <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric Gas Olher <br />A�u�n���../ <br />NO. I TYPE OF FiXTURE OR ITEM <br />% <br />� <br />Toilet <br />Balhlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Cblhes washcr <br />Water healer <br />Sink (survice/bddmop/etc.) <br />Back(low preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />NO. 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 drycr <br />Rangc hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Rofrigeretion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby cerility that I have read and examined this applicalion and know the same fo be true and correcl All provisions of laws and <br />ordinaces goveming this lypc ol work will be complied with whether speci(ied herein or nol. The granling of a pertnit does nol presume <br />to give authority to violate or cancel the provision of any olher state or local law regulaling conslruclion or ihe pedormance of <br />consiruction. That I am aulhorized by lhe owner of lhis propeity ro pedorm the work (or which applicalion is made and I comply with the <br />Slale Conlractors Law 18.27 RC�1(J and 296200 WAC. <br />