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LOT <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-7.57-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />PARCEL TAX I.D. # <br />1�( S c,J . �) (UU ZUU �S(,� <br />BLOCK TRA <br />� � e N r..� n r��� C�'e S-� <br />�J �L0.�` • �t U l� � .1..�� <br />TENANTNAME <br />CONTRACTOR �',� � C IZ IL �( fi� L%. <br />�� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />� f- 17 . <br />WORK DESCRIPTION <br />Z`{� l � S�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Ciothes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />�M ; A - `(L <br />CONTACT FOR PERMIT <br />ADDRESS <br />HERTSOURCE <br />Elechic� Gas _ Olher <br />CITY2IP <br />PERMiT # <br />, . � �2 :3� <br />PHONE <br />llC . S�lvt.. ' <br />�✓�'* Z�iS p�/,u <br />PHONE <br />PHONE <br />y�s Z5'9 •UIlGu <br />CONTRACT PRICE OF WORK <br />NO. I 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 />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied wilh whether specified herein or not. The granting of a permit does not presurtie <br />to give authority to violate or cancel the provision of any other slale or local law reguiating construction or the perfortnance of <br />construction. That I am authorized by the owner of this property to perform the work for which applicaGon is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />SignaWre of OwnedContractodAulhorized Agent Date <br />' �/ <br />