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PERMIT APPLICATION <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 />.�2CC� -�-���o <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />LOTNO. � BLOCK <br />PARCEL TAX I.D. N <br />S,^ Ile_�)G�- <br />eJ <br />�RMI`?R' �7 _ / <br />a' <br />TENANTNAME `''CONTACTFOR�PERMIT , PHONE <br />4-�0.r•a�� ��z.��� ( 2�Uc� - y l�- lo�t�('1 <br />CONTRACTOR ADDRESS qTYlLP PHONE <br />Y}fi��SanElOMesz�c. �o�ai EvugreenWy+�a,5•�I73 �vue1-�48aDi y�•y3iS-la3b�j <br />CONTR. LICENSE �I <br />USE OF BUILDING <br />WORK DESCRIPTION <br />iG# 135 <br />N�. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbar/mopletc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floordrain <br />Grease trap <br />Roof drains <br />Other _ <br />HEATSOURCE <br />_ Electric �Gas _ Other <br />CONTRACT PRICE OF WORK <br />t� f UJ CC.,—i' 110.Yv� e, a <br />LA,R Q� <br />„� � <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — 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 />Waodstove <br />Other� <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS �705 <br />I hereby ceritify thal I have read and examined this application and know the same to be true and corred. All provisions of laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or not 7he granting of a pertnit dces not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the perfortnance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296200 WAC. <br />i <br />o� � S <br />