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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9820t <br />425-257-8810 — FAX 425-257-8857 — wntiv.everettwa.org <br />�%�o���- <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PqpCEL TAX I.D. / PERMIT /\ <br />� �l� !� Lc� �fJ(Q (iDlO L�D I L. �lt, �� �;' � <br />DESCL LOTN � BLOCK TRACT ' r �� r <br />Hf�SGn `NDMES �.inc IDI'2 <br />TENANT NAME ' <br />IV �— <br />CO TR CTOR <br />�r�,�n �VoMe�.Jnc. <br />CONTR. LICENSE /,�tiYs s� r a55c 3 <br />USE OF BUILDING <br />WORK DESCRIPiION <br />LL�� <br />TYPE OF FI%TURE OR ITEM <br />I1 otlet <br />8athtub <br />lavatory (wash basin) <br />Shower <br />Kdchen sink 8 disposal <br />Dishwashei <br />Clolhes washer <br />Leundry tray <br />Sink (service�bar/mop/etc ) <br />Backflow prevenler <br />Urinal <br />Dnnking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other_ <br />� <br />FOR PERMIT <br />ADDRESS <br />�aM¢ G5 �wne,( <br />HEATSOURCE <br />_ Elechlc ��es <br />I:AII <br />`1.3 �.ve(di'1�(I7� �}Z5�H3��,3�9 <br />PHONE <br />CITY/ZIP PHONE <br />�-IZb"-N3���bfiQ <br />I CONTRACT PRICE OF WORK <br />Other <br />�\L�' ��S <br />�1�1 <br />MECHANICAL <br />TYPE OF FI%TURE OR ITEM <br />A/C — air ha�idling unrts <br />Forced air syslems <br />Gas pipmg <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />EMhaust fan <br />Heat uump <br />Unil heater <br />Boiler <br />Refrigerati; : <br />Woodstavrr <br />Other__ <br />CITY OF EVERETf LOCAL SALES TAX CODE IS 7706 <br />I hereby cerilify that I have read and examined this epphcation and know the same to be true and correct All prowsions of laws and <br />ordmaces governing this type ol work will be complied wdh whether specified herein or noL The granling of a permd dces not presume <br />to grve authority to violate or cancel fhe prowsion ol any olher slale or local law regulating conalroction or the performance a! <br />constm��ion Thal I em aulhonted by the owner of this property to peAortn the work for which epplicalion is made and I comply wilh the <br />Slate Cunlraclors Law 18 27 RCW and 296200 WAC. ` <br />\ �\ <br />Signalure o OwnerlContractodAuthmaed Agent a�e <br />��ZJ �� � <br />