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PCkiVIIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIOtJS ARE ACCEPTED FROM 8 AM TO 4 PP�I - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SiTC ADDRESS <br />s �,o "F�,-„-�,Z,,,E GJ <br />I.EGAL LOT N0. ELOCK <br />oesc. 3� ,�oa�-� <br />PARCEL TAX I.D. # PERMIT # <br />� ca��v�ooZ o«�s a� C5/b = <br />TRACT <br />,�''Ec / ;�r� z.Fr,�/ i2�F LJN <br />���E �,a6E (On�s,— /�� ` /����rz� 3� = �U�a�c ,"�J,9 �?� 8„���,3 <br />TENANTNAME CONTACTFORPERMIT , PHONE <br />.. • , i I . � ' . _ ', . <br />CONTRACTOR ADORESS <br />`I�Lut�' /e/ti6E �v,v;;,- /�,c. "�i o3cx 3� = <br />CONTR. LICENSE # <br />�«.�'2er9��; TT' <br />USE OF BUIL�ING <br />�.Jl.v��t� /�Yrt,�y /�Es <br />WORK DESCRIPTION <br />HEATSOURCE <br />CITY2IP PHONE <br />?J�v�� 9�'g ��,c� Fri9-'��/.3 <br />,. ,. <br />_ Electric X Gas _ Other <br />CONTRACT PRICE OF WORK <br />� %F�S�000 <br />�/�� �J��v ��,��,� ���.. �� � i �5 <br />NO. I TYPE OF FIY,TURE OR ITEM <br />S Toile[ <br />� Bathtub <br />�Lavatcry (wash basin) <br />Shower <br />� Kitchen sink & disposal <br />�IDishwasher <br />Clothes washer <br />( ! aundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Fioor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C - air handling unifs <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas ran9e <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other_ <br />CITY OF EVERETi LOCAL SALES TAX CODE IS 3'105 <br />I hereby ceritify that I have read and examined lhis applic3tion and know the same to be true and correct. All provisions of laws and <br />ordinaces govemirg this rype of work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />to give authcnty to violat or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am ut rized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors �aw . RC� and 290.200 AC. <br />:�l'� � �C%-��O) ' �. <br />Signature or OwnenContractorlAuthonzed Ayent Date �'/ <br />.a <br />