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P� ���IIT APRLICATION <br />CITY OF EVERETT PERMIT SERVIC�S <br />3200 CEDAR STR�GT, EVEF2ETT, WA 98201 <br />425-257-8810 — 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 />LOT <br />U�id� �� <br />BLOCK <br />��UC �i'fi� W.tF�T /NG' <br />TENANT NAM1tE <br />PARCEL TAX i.D. # PERMIT # <br />w Fsv�o�nozoo i�dv ��lC' � <br />TRACT LGNLa<JCYC7'�C'�L/�" <br />�C(: l %iJ/� � J/� ,� `f- G� (i.J.l•1 <br />ADDRESS CITY2IP PHONE <br />����c�c �07 `/�uva�.- 980�% �zoc� r�/i'-�d.3 <br />CONTACT FOR PEfth71T <br />PHONE <br />�CO7NTRACTOR/J /l ADDRE55 CITYC2�IP PHONE <br />/dLc./C /L/bE.E �-OuST �.VC �%r��3t 6K 3���- �u.4�c. /a'J/% �Z.06� &��%'�`i%3 <br />CONTR. LICENSE # ��• �� _� � � � ' , <br />�e e L 986�7' � <br />USE OF BUILDING <br />�CS <br />4VORK DESCRIPTIO�' <br />HEATSOURCE <br />_ Electric X Gas _ Other <br />CONTRACT PRICE OF WOP.K <br />/�(Ec.� GJtra� �q-�-,E-� �1=2 �sic'� f 63 <br />NO. I TYPE OF FIXTURE OR ITEM <br />S Toilet <br />Z Bathtub <br />� Lavatu:; (wash basin) <br />� Shower <br />� Kitchen sink & disposal <br />/ Dishwasher <br />_� Clothes washer <br />� Laundry Lay <br />Sink (service/badmop/etc.) <br />Backflow prevenier <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />� <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C - air handling uni(s <br />�— Forced air systems <br />� Gas piping <br />� Waterheater <br />/ Gas fireplace <br />� Gas range <br />�- Clothes dryer <br />7 Range hood <br />� Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />I hereby ceritify that I have read and examined lhis application and know the same to be lrue and correct. All provisions of laws and <br />ordinaces goveming this type of work will be complied •.vith whether specified herein or not. The granting or a permit does not presume <br />to give authonty to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />conshuction. That I a authorized by the owner of lh�s property to perform the work for which application is made and I comply with lhe <br />S(ate Contractors Lav 27 RCW and 296.200 WP.C. <br />� �C 9�' %�� /C�- ,�j -O� � <br />Signature of OwnenContractouA�thorized Agent Date z <br />