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PL�MIT APPLICATI��J <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9R201 <br />425-257-8811— 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 />�S� <br />LEGA LOT N0. <br />DESC. <br />�l�7�r Sr _ <br />� nLOCK TRACT <br />PARCEL TAX I.D. # <br />PERMIT # <br />......_.t�GoKS��KR 18z�, R�t��R- /9y�. .....,_„ ....,.._ tiZ5 <br />���T� �1�20� z3z �'S'� Z <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />� �j9 (�pNr� OG✓NcJL_ <br />CONTRACTOR ��p ]�cyf�,��.N��.rr �p ADDRE55 <br />ie•� S"I7L GQ-T�•.�l <br />CONTR. LICENSE # �� ��� L o� 6 Z�, L <br />USE OF BUILDING <br />-lj/NCLE F�r+i[,y ��S <br />WORK DESCRIPT�ON <br />f�f�Pr p� � yuv,� <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposai <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Oackflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drein <br />Grease trap <br />Roof drains <br />Other <br />IHEATSOURCE <br />� Electric Gas Other <br />�4Do nisHr,,.r1�HE2. <br />NO. � <br />CITY2IP PHONE <br />CONTRACT PRICE OF WORK <br />¢ I DoU <br />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 />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Waodstove <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 7105 <br />I hereby ceritify that I have read and examined this appllcation and know lhe same to ba true and correct. AI� provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. Tho granting of a pertnit does not presuma <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the perfortnance of <br />construction. That I am authorized'oy the owner of this property to perform the work for which application is made and I comply with the <br />State CopMaetuc�s Law 18.27 RCW and 296.200 WAC. <br />(— l �' <br />