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F'L--f�M1T �4PPLICATIL�V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />4�5-257-8810 — FAX 4�5-257-8857 — www.everet?wa.org <br />APPLICA,TIONS ARE ACCEPTI=U FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE AD�RESS PARCEL TAX I.D. # PERMIT # <br />S'��'-� r3;-a,� i�2�v��%� ZSo oi�ozvo£6o ��'S/Z -33 <br />LEGA LOT NO, BLOCK,, ��( /T�RACT <br />oESc._ �.� ��ld'1�c/�1'!'' C..'7 C.Ea/cJL`r�� �2r'S i C� �� /- O 5� <br />_� <br />_:.�c:ucr— ., <br />TENANTNAME <br />� � :3.� 3 <br />CONTACT FOR PERMIT <br />9��, ��<} 6>>- ��, <br />PHONE <br />CONTRACTOR AOORE35 <br />CITYIZIP r-� PHONe <br />.^-� '�> c�� /�cJaA�� <br />,Uc.ci�'l��JbE' -.�S%7z�c�)c�✓,�c. i v K?r.�� `�b'U�/ <br />CONTR. LICENSE # � ��uE.� 6/ 7- �' `✓/.3 <br />�c,�� 2e1 9FlF� TT <br />USE OF BUILDING <br />5...��.,� ����c� �-s <br />WORK DESCRIPTION <br />ti� � <br />HEATSOURCE <br />Electric X Gas _ Other <br />(�Jarr� ��An-,r� �N.P_ <br />PLUMBING <br />NO• I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink $ disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servi�e/bar/mop/etc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />� � �l �'p nzJ <br />� <br />�,� /�8, <br />NO. I '{�'PE OF FIXTURE OR ITEK <br />rvt; - air nantliing units <br />/ Forced air systems <br />�- Gas piping <br />T Water heater <br />� Gas fireplace <br />�Gas range <br />C�othes dryer <br />�- Range hood <br />� Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examinzd this application and knew the same to be true and correct. All provisions of laws and <br />ordinaces govemin9 lhis type of work will bz complied with whether specified herein or not. The granting of a permit does not presume <br />to give authonry to violate or cancel the pro �ision of any other stale or local law regulating construction or the performance of <br />construction. Th t I m authorized by the owner of this property to perrorm the work for which application is made and I comply with the <br />State Contractors l w 18.27 RCW and 296.200 WAC. <br />�G, <br />-/�'' O <br />