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F�RMIT APPLICATIi�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />,� /oo/ si.f,- Pc sW <br />LOT NO. I BLOCK <br />DESC. <br />IPARCEL TAX I.D. # <br />oo,s66�oo00/900 <br />?RACT <br />S'EAHv2J'r /HA.vo� <br />�l��i�A�c/�,tio� y�s-�s�-o�c� <br />h,aH�.✓C y ���� S�s% �� J'v✓ EvE2r;-r fwr+ 98zo3 <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />.JI n1 zL7v � � S c�'�v � <br />CONTRACTOR �`G � y„� � �. v� ��� <br />CONTR. LICENSE # <br />AGL T!/7 <br />USE OF BUILDING <br />WORK DESCRIPTION <br />V <br />ADDRESS CITY2IP PHONE <br />0���,9 ��ST/i AvG J_F Ki=n�; W,n 9a �3� <br />. . <br />HEATSOURCE <br />Electric Gas <br />NGw f,�o..� �,�vs,c % D�uc <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbar/mop/elc.) <br />Backtlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drafn <br />Grease trap <br />Roof drains <br />Other <br />d�b -s�s-.lso„J <br />I CONTRACT PRICE OF WORK <br />Other � � oo„ ��L <br />NO. � 7YPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas aiping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />� <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby ceritify that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br />ordinaces governing tliis type of work will be complied with whelher specified herein or not. The granting of a pertnit does not presume <br />to give authoriry to violate or cancel the provision of any other state or local law regulatinq wnstrucGon or the performance of <br />construction. That I �a }authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State ContractorsC3n418.27 RCW and 296200 WAC. <br />-s��b oS <br />Dat <br />%a <br />