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- — r- <br />PERMIT APPLICATI(�N <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 />SITE ADDRESS <br />�3 ig sc.��`S <br />LOT N0. <br />q�- <br />/'rl G 1 � \�'v�J I <br />�. . , .r, vv� ✓ <br />TENANTNAME <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />PARCEL TAX I.D. # <br />ool�lvzo <br />TRACT) OR SUBDIVISION # <br />�I�r2.ltiJOn1� <br />3� ='2_G Wlau�i-c�;.� <br />CONTACT FOR PERMIT <br />�;�r,� L �.���, <br />•� <br />�`��� <br />�� ,��� �-0�7 <br />PERMI # <br />� � °� �°�� <br />i�NE ��a <br />I P ♦_ " <br />PHONE <br />3�0 �od oS3� <br />e-Ma� _ <br />�7RACTOR L I J ,:J C6�u S^f' �LyzV S� � _...._.. 36� <br />�e �'Lfcrysu� ��e �o� 03�7 <br />CONTR. UCENSE p �_� I_ v� l �g �d <br />� <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />Electric _ Gas _ Other <br />PdI�7� <br />�,� �1 Q Q/�G`�1"' � �(�� `1�— <br />t/ <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Cluthes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />O�her <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaust (an <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3705 <br />I hereby ceriti(y lhat I have read and examined lhis application and know lhe same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied wilh whelher specified herein or not. The granling of a permil does not presume <br />to give authorily to violate or cancel the provision of any other state or local law regulating conslruction or lhe peAormance of <br />construction. That I am aulhorized by the owner of this property lo perform the work for which application is made and I comply with the <br />State Coniractors Law 18.27 RCW and 296.200 WAC. <br />Signature o( Owner/ConlractodAulhorized Agenl Dale <br />