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PtRMIT APPLICATI(��I <br />CIT'Y OF EVERETT PERMIT SERVIGES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS � /1 <br />��UH 3?.w0 ,y i fl <br />LEGAL LOTNO. BL/OCK <br />DESC. e, 2 �L/j ' <br />OW NER <br />�-u� Grtiwi�r% 31�0 <br />TENANTNAME I <br />CONTRACTOR-- <br />J� Cl�i✓`�T <br />CONTR. LICENSE # <br />USE OF BUILDING <br />�o�� Sli��x(.`i �/an111)f �N�kb� <br />WORK DESCRIPTION <br />,.�,.�o� 3 TowN�aks� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bath�ub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />W ater heater <br />Sink (service/bar/mop/eta) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />PARCEL TAX I.D. # <br />Oou3No � <br />TRACT OR SUBDIVISION # <br />ADDRESS <br />�uc�z� P� A✓�, <br />CONTACT FOR PERMIT <br />7lJ C���JI,-!7 <br />ADDRESS <br />312D Gl-p <br />HEATSOURGE <br />., ,_ �_ Eleclric � Gas _ Other <br />� --/�--i� <br />�w 8� v -20 <br />PERMIT # <br />C' o��o �o� <br />-OG`�� <br />PHONE ? y J _'v / � y <br />.J IJ <br />CONTRACT PRICE OF WORK <br />27.SGCD,ob <br />;;9g <br />,3a; <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />� ForcGd air systems <br />� Gas piping <br />� Waterheater <br />Gas fireplace <br />Gasrange <br />__(_ Cblhes dryer <br />� Range hood <br />5 Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />_ Re(rigeration � <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y thal I have read and examined this applicalion and know lhe same lo be lrue and correct. All provisions of laws and <br />ordinaces goveming this type of work will be complied wilh whether specified herein or r.oL The granting of a permit does not presume <br />l0 9ive aulhoriry to violale or cancel the provision of any olher s�ale or local law regc:'!'�g construclion or the pedormance of <br />construction. That I am aulhorized by lhe owner of this property to perform lhe work for which applicalion is made and I comply with ihe <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />Signalure of OwnedContraclodAuthorized Agenl Dale <br />��a <br />