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P�RMIT APPLICATIt�N <br />CITY OF EVERETl' PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - wnvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS pARCEL TAX I.D. # PERMIT # <br />i�o3-�2 sf5� �I f} I I I"VI D�o(v- <br />LOT NO. <br />DESC. <br />TRACT <br />s�i�n �el, ��^ �z3yS�aKc GiY f��y/`l� �i 397 Sea7��c C�A �g/z5- <br />TENANTNAME � I CONTACiFORPERMIT PHONE <br />�n �/Z�rJ 3��-SZi-Z. <br />CONTRACTOR ADDRESS CI7Y21P PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />�N�f ��.'i�' <br />V <br />WORK UESCRIPT�ON <br />/1.Q iJ %4S <br />NO. I TYPE OF FIXTURE OR ITEM <br />—I <br />Toilet <br />Bathtub <br />Lavalory (wash ba�in) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Barkflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />HFATSOURCE <br />�Electric � Gas _ Other <br />CONTRACT PRICE OF WORK <br />�� � <br />NO. I TYPE OF FIXTURE OR ITEM <br />A1C — air handiing units <br />Forced alr syslems <br />� Gas piping <br />Water heater <br />� Gas fireplace <br />Gas range <br />� Cbthes dryer <br />Range hood <br />Exhauslfan <br />Heat oump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3705 <br />I hereby ceritify thal I have read and examined lhis application and know the same to be true and cortect. All provisions of laws and <br />ordinaces governiny this type of work will be complied with whether specificsd herein or not. The granting of a pertnit does not presume <br />to give autherity to violate or cance.l the provision of any olher state or focal law regulating consWc6on or the performance of <br />construction. Thal I am authorized by the owner of this property to pertorm the work for which appiication is made and I comply with the <br />Stale Conlractors Law 1F3•27 RCW and 296200 WAC. <br />�, . ��xyn�J (d / <br />?_ D 5'— <br />