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PtRMIT APPLICATIVN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.ev�:rettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITEADDRE�,I I ���5� <br />LEGAL LOT NO. BLOCK <br />DESC. <br />OWNER <br />�� Jv�1 � �tSlc..� . . � <br />TENANTNAME <br />COnTRACTOR <br />CONTR. LICENSE # j ,[��� <br />�� <br />USE OF BUILDING <br />,/ SiIJGw <br />flD� F,aM�w f <br />WORK DESCRIPTION�Y�' =� <br />Ci' <br />TRACT <br />��1 , l.w� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen �ink 8 disposal <br />Dishwas'1er <br />Clothes�:asher <br />Water neater <br />Sink (service/barlmop/etc.) <br />BackOow pieventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roo( drains <br />Other <br />ADDRESS <br />EL TAX I.D. it <br />35'7.7�-'0%��/ <br />CITYIZIP <br />� w � � �� <br />PERMIT <br />CIN21P <br />HEATSOURCE <br />_ Electric /Gas _ <br />Other <br />�1� <br />H � � y -�,6 <br />P RM # <br />� D,P-�1�' <br />� <br />ZS3- 222-2"1 � % <br />PHONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />�o1G/.5 <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gasran�e <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Wuodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this application and know the same to be true and correcL All provisions of laws and <br />ordinaces governing lhis type o( work will be complied with whether specified herein or not. The granting of a permil does not presume <br />to give authority to violale or cancel the provision o( any other slale or local law regulating construction or the peAormance of <br />construclion. That I am aulhorized by lhe owner of this property lo periorm lhe work for which application is made and I comply with lhe <br />Slale Conl�IQrs Law 18.27 RCW and 296.20� yVAC. <br />