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PE��MIT APPLICATIC?�,� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />LOT NO. BLOCK TRACT <br />N Z M�P oF �A1e�in14Tv�( CSP-`l3 <br />P RMITN <br />Qyo�-oa <br />lJ/WE S� �F„�JE �02�(iE1G Z`lLy �llYco2 UQ E�Hl<-iT 487�03 <br />. <br />TENANT NAME I CONTACT POR PERMIT PHONE <br />�%oRrti �c.u��z yzs'- 359- �487 <br />CONTRACTOR /JSL LiE/J,Q��'TR��T��'s ADURESS ZSfB "'j�J1�Yt��L CITY2IP PHONE yZy-• 3Sq-�q8� <br />CONTR. LICENSE X y �,�.rr <br />/�/ScGE/ �s�o �5�23%05) <br />USE OF BUILDING <br />5�� <br />WORK DESCRIPTION <br />� F„('.(G � (�o2e N ��� <br />NO. I TYPE OF ^%TURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchzn sink 8 disposal <br />Dis; iwas her <br />Ciothes washer <br />Laundry tray <br />Sink (aervice/badmop/etc.) <br />, _ Backflow preventer <br />� Unnal <br />Drinking Fountain <br />� _ F�oor drain <br />Grease trap <br />Roof drains <br />i Other <br />HEATSOURCE <br />Electric _ Gas _ Otner <br />N0. <br />CONTRACT PRICE OF WORK <br />�3Y.��o 22,02� <br />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 dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />� CITY OF EVERETT LOCAL SALES 7AX CODE IS J105 <br />'� I hereby ceritify ihat I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />� ordinaces goveming this type of work wili be complied with whether specified herein or not. The granting of a pertnit does not presume <br />to give authority to violate or cancel the provision of any olher state or local law regulating construction or the perfortnance of <br />construction. That I am authorized by the owner o( this property to perform the work forwhich applicatlon is made and I comply with the <br />State Contractors Law 1$.27 RCW and 296,200 W�C. <br />��— l�i ��i, ,.y S� zo - o�l <br />