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�� <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 �,� <br />425-257-8810 — FAX 425-257-8857 — vwvw.everettwa.org g"" � <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM - DEBIT 3 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />sos d' 6cq <br />LEGAL LOT NO. <br />DESC. <br />s �.o f �4w1 <br />�Jao�� �%r <br />BLOCK TRACT <br />�//�� r ADORE <br />�Z�I/ 1-S Il•!� <br />PARCEL TAX I.D. M <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />Dly.,�;� (�uu �i�r� :Toe J�e,,,,n,.� (�o► -7�►�{-(G21 <br />CONTRACTOR �tr� �M' , �i ADDRESS CITYILP PHONE <br />� 'r ���i, TyP s� J� �(5 Ma�wr w/� ?pi �� <br />CONTR.LICENSEi W��FGIiF`%��`"a� �?�(�0� _%Y�•a��„� <br />USE OF BnUILDING <br />(� � <br />���n7;H I <br />WORK DESCRIPTION <br />.Sfi<<.��+r� e �e�u� � <br />N0. I TYPE OF FI7(TURE OR ITEM <br />Toilet <br />Balhtub <br />Lavarory (wash basin) <br />Shower <br />Kdchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/barfmop/etc.) <br />Backflow preventer <br />Urina� <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />HEATSOURCE <br />_ Eleclric _ Gas _ Olher <br />N0. <br />CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A/c — air hantlling urnts <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas f replace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Waodstove <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 7105 <br />I hereby ceritify that I have read and examined this application and know lhe same to be true and correct. AII provisions of laws and <br />ordinaces governing this rype ol work will be complied with whether specified herein or not The granting of a permit does nol presume <br />to giva authority to violate or cancel the pwvision of any olher state or local law regulating construdion or the performance of <br />conslruction. That I am authorized by the owner o( this property to perform the work lor which application is made and I c?mply with the <br />State Contr ctors Law 18.27 RCW and 296.200 WAC. <br />� �lil�� <br />