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PcRNIIT APPLICI�T{C�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evarettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4!'M <br />SITE ADDRESS <br />` y�� �: i 5'��� �'� <br />LEGAL LOTNO. BLOCK <br />DESC. G O / <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE kl <br />c��, <br />USE OF BUILDING <br />S l�z,.g,�.:.� . �. <br />Pi�C�73: <br />i�� <br />PARCEL TAX I.D. # <br />G30 � 6 .(. U U% G v 6 0 <br />TRACT <br />Q' �'/ 'J 2 j/i'� <br />ADDRESS CIl <br />/U� � 5 ���z.,lLR,u <br />CONTACT FOR PERMIT <br />PERMIT �I �J <br />f o/ �1 jGl� - / <br />PHONE �4S_�JS F=2y <br />ADDRESS CITY/ZIP PHONE <br />� <br />'`-'-T"� { �fZ�= �:1-os�7 <br />Y 3 i .', ,S'f'�frs� / <br />� G�� yS�d 5 <br />HEATSOURCE <br />Electric __ Gas _ Other <br />� `� � ����� <br />N0. I TYPE OF F�XTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitclien sink & disposal <br />Dishwasher <br />Clolhes washer <br />W ater heater <br />Sink (service/badmop/elcJ <br />Back(low preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />NO. <br />CONTRACT PRICE OF WORK <br />,,/, ? <br />�i-;.�.'� �� r lo� S L�L.� <br />TYPE OF FIXTURE OR ITEM <br />FVC — air handling unils <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Cblhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodslove <br />qTY OP EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify ihal I have read and examined this applicatiun and know the same to be true and correcL All provisions oi laws and <br />ordinaces goveming lhis type of work will be complied with whether specified herein or not The grantin9 of a permit does not presume <br />to give aulhoriry lo violale or cancel lhe provision of any other stale or local law regulating consWction or the per(ormance of <br />conslruclion. That I am aulhorized by the owner of ihis property to perform the work for which application is made and I comply wilh the <br />State Co�t;actors Law 1t3.27 RCW and'19G.200 WAC. <br />jb/E�G <br />