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SITE ADDRESS <br />� � �� <br />LEGAL LOT NO. <br />TENANTNAME <br />PFF2IVIIT APPLICATION <br />CiTY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-F+857 - nnvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FRJM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />� <br />«�-��u-��I �✓L.�-��,vF���/��'/L��z <br />CONTRACTOR n <br />�� <_.� tr IG i 7GG `<ir. � : <br />CONTP.. LICENSE # <br />2Cz 9b�E� J"! <br />�✓ C_. <br />'�v ��sk 5d�. <br />� CONTACT FOR PERMIT <br />AUDRESS <br />��0�(J<,yC ''.�✓G- <br />USE OF BUILDING <br />�.J/ .�/ 6 c� %il "F�f t [..c..� �� <br />WORK DESCRIPTION <br />•—� � -�-- � <br />(JA��G ( � � i5 <br />9fai� <br />/) <br />�- `�;�X� -- /.3 <br />RMIT # <br />�=�� -- // <br />'P_�C w�� <br />/Pt10NE\ <br />( '�Jb/9- r-/� 3 <br />PHONE <br />� CITY2IP PHONE <br />/J✓✓Rc..L I��/� . <br />• ' ' (��cx..� �i %-�'1/3 <br />HEATSUURCE <br />_ Eleclric / `Gas _ Olher <br />PJE�� �ti.,�:��,�,�.F,�E� �G,� <br />:70. I TYPE OF FIXTURE Of: IT'_M <br />�� TOIICI <br />�Balhtub <br />Lavalory (wash basin) <br />Shower <br />�— Kitchen sink 6 disposal <br />/ Dishwashcr <br />= Cbthes washer <br />Laundry tray <br />Sink (service/badmop/elc.) <br />Backflow prnvenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />NO. <br />CONTRACT PRICE OF WORK <br />�//S, ��� — <br />TYPE OF FIXfURE OR ITEM <br />NC — air handlinc� units <br />Forced air s��stems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas ranc�e <br />Clolhes dryer <br />Range hood <br />Exhausl fan <br />Heat purrN <br />Unil hr;ater <br />Doiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby ceriti(y that I have read and examined this applicalion and know lhe same to be true and correcl All provisions of laws and <br />ordinaces governinc� this type of work will be complied wilh �die�her specified herein or noL The granling oi a permit does not presume <br />to give aulhority to violate or cancel the provision ot any other slale or local law regulaling construction or th�: pedorrrance of <br />constructiqn. Thal I am authorized by the owner of ll-�is property lo pedorm the work for which application is made and I comply with the <br />State Con'tracto�e i_aw 18.27 RCW,and 296.200 WAC. <br />/ /v <br />�t� l--C �% �' C �-�Z���� <br />Signature of OwnedContractorM.ulhorized Agent Date �' L <br />t <br />