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SITE ADDRESS <br />s�LEGAL LOT N0. <br />� <br />�h <br />PERMIT ANf�LICATION <br />CiTY OF EVEREiT PERMlT SERVICES <br />3200 CEDAR STREET, EVERETT, VVA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everethva.org <br />APPUCATIONS ARE ACCEPTGD FI2UM 8 AM TO 4 PM <br />PARCEL TAX. I.D. # <br />BLOCK T�RACT n <br />!n I E'/1 W Ud Qr C,�hF'�$ � <br />y2� <br />�� rP .!� % tS'oZG'% _ � 5 7 <br />Ll�CJc�� � <br />TENANT NAME C JNTACT FOR PERfd1T PHONE <br />� � � ' , r3;�/ �.,�;JG�� ��: y2�"a,3-S��'�� <br />CONTRACTOR �C+�����s hr�,G hJ�� ADDRESS CITY/ZIP PHONE <br />s�������s c<< ��''�`»-vL / � j� 'l.�� -z93-Sd�z <br />CONTR. LICENSE # �� .) L j /3-L'c ��L' h � 'C �� " � � <br />N �� � � <br />L.CInAIC� �i�t��_ _ �•� / — <br />USE OF BUILDING <br />� � I�--.. <br />WORK DESCRIPTION <br />Cp ,.> •, T2 uc. � - <br />NO. <br />Now SFt2 <br />TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />HEATSOURCE <br />Electric �as Olher <br />� ^ "�'� � 1 ' <br />I�� '_.(c:. 4'..� <br />NO. I <br />CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas (ireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Eoiler <br />P,efrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby cerilify lhat I have read and examined this application and know the same to be true and co«ecl All provisicns o( laws and <br />ordinaces yoverning this lype of work will be complied v+ith whether specified herein or nol The granting of a permit does not presume <br />to give authority lo violate or cancel the provision of any other state or local law re�Waling consUuction or lhe per(ormance of <br />construclion. That I am aulhorized by the owner of this property lo perform the wurk for which application is made and I comply with Ihe <br />Sfate Contractors Law 18.27 RCW and 29G.200 WAC. , <br />SignaWre <br />