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SITE ADDRESS <br />'' S ,� <br />LEGA l0T NO. <br />PErtMl7 APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.urg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK TRACT <br />CJC� q- D-D I `;,�b <br />PAe2CEL TAX I.D. A <br />'-7i7.. f.�-- o1U-� <br />/b`�`3-'O� <br />:RMIT # �/ <br />��n � � '_7' <br />�l�h,,��s ti�ti,r ��-5�,� s�� � so�« < u�. ev- � g� �-�-s�s���rs3 i <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />CONTRACTOR�� ����� ��y(.V�C��,i.��,SADDRESSJO/'�7 <br />CONTR. LICENSE R <br />USE OF BUILDING <br />WORK DESCRIPTION <br />Q�r�r� <br />NO. � NPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />"ilchen sink & dispesal <br />Dishwasher <br />Cblhes washer <br />Waler healer <br />Sink (servicelbadmop/elc.) <br />Backtlow preveNer <br />Urinal <br />Drinkin� founlain <br />Floor drain <br />Greasetrap <br />Rool drains <br />Olher <br />HEATSOURCE <br />�v, CITY2IP <br />i, G1 V (l.`I$,�c:�s <br />Eleclric Gas Olher <br />PHONE <br />�- �-s-,s�r -lb 3 <br />CONTRACT PRICE OF WORK <br />N0. 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 ranc�e <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9705 <br />I hereby cerilify lhat I have reau and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing lhis typo of work will be complied wilh whelher specified herein or noL The grenling of a permil doos nol presume <br />to give aulhority to violate or cancel the provision of any olher state or local law regulating construction or lhe performance of <br />construction. That I am aulhorized by the oH•ner of Ihis property to pedorm lhe work tor which application is made and I comply with the <br />State Co tr clors�Law 18 RCW d 296.200 WAC. <br />�� i � <br />/�l , �' � ( � �� .� �c � -- <br />