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PCRMIT APPLICATI(�N <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />� <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />�Q��rie, <br />TENANTNAME <br />c �*, P` � OC <br />BLOCK TRACT <br />CONTRACTOReN �oC1�IV�� <br />CONTR. LICENSE M CM `yC/1Z �D <br />USE OF BUILDING <br />7l3 <br />PARCEL TAX I.D. # <br />i4a4nannn <br />ICONTACT FOR PERMIT <br />ADDRESS <br />IUIS PjrOad�Ucu-' <br />HEATSOURCE <br />_ Elechic ✓ es _ Other <br />CITY2IP <br />E�eve�tfi <br />q $ 201 <br />WORHDESCRIPTION I1�S�U� I � C�QQ-i�Q.n�.C� �Ir�l�� <br />N0. I TYPE OF FIXTURE ON ITEM <br />Toilet <br />BathWb <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 dlsposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (serviceibadmap/etc.) <br />Backflow preventer <br />Unnal <br />Dnnking Fountain <br />Floor drain <br />Giease trap <br />Roof drams <br />Other <br />�f�5 - <br />PHONE <br />PHONE <br />y75 25�=1 (olo(oh <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air hendling units <br />Forced alr sysfems <br />Gas piping <br />Water healer <br />� Gae fireplece <br />Gas range <br />Clothes aryer <br />Range hood <br />Exhauatfan <br />Heat pump <br />Unit heater <br />Boiler <br />Retrigeretlon <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TA7( CODE 19 9103 <br />I hereby cerility Ihal I have read and examined lhis application antl know tha same to be true and corract. All proviaions of lews and <br />ordinaces goveming this typa of work will be complied wdh whether specfietl harem or not 7he granting o( a p�,rmd does nol presume <br />to grve authonty to violate or cancel Ihe provision of any other stale or local law regula�ng constructlon oi the peAormence af �. <br />construction. Thal I am authonzed by the owner of this property to peAorm the work for which application is mede and I comply with the ' <br />Slate Contractors Law 18.1j,RCW and 296.200 WAC. I <br />