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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 �n�� D <br />425•257-8810 - FAX 425-257-8857 - ativw.everetiwa.org ,nC� � �U <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT d CREDIT CARDS ARE NOT ACCEP7ED <br />SITE ADORES <br />LEGAL LOTNO. <br />DESC. _ 1 I <br />�_L. <br />owN 'R <br />�f��n `�E <br />TENANTNAME <br />PARCEL TA% I.D. N <br />S�� <br />BLOCN TRACT <br />ADDRESS <br />� IC�1'LI �e.r �'e.e.nl,Jv�15-y`I_ <br />I CO TACT FOR PERMIT <br />CO TR CTOR <br />�-r��� �VoMc�.Jnc. <br />CONTR. LICENSE M I��`r1 SIT Y�{2��C..�J <br />USE OF BUILDING <br />WORK �ESCRIPTIOM <br />NO. I TYPE O% FI%TURE OR ITEM <br />tailet <br />Bathtub <br />Levalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwashe� <br />Clothes washer <br />Laundry Iray <br />Sink (serv�ce/barlmopletc ) <br />BackPow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />ADDRESS <br />�arne f�S u�Jne� <br />HEATSOURCE <br />_ Electric �Gas _ Olher <br />PERMIT I <br />�fUl� C �coo � - O <br />CITYILP PHONE <br />�e�� �t$2(�i �ZS�H3f��3�4 <br />PHONE <br />Zol� ��-('l� L���l� <br />CI:Y21P PHONE <br />ur�-N3�-�ca�4 <br />� CONTRACT PRICE OF WORK <br />i- <br />13ASiC.� �q'i <br />� 7 �,~ n <br />N0. I TYPE OF FIxTURE OR ITEM <br />AlC — air handiing units <br />J . Forced air systems <br />� Gas piping <br />� Waler healer <br />� Gas fireplace <br />Gasrange <br />� Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit healer <br />Boiler <br />Refngeretion <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J1�S <br />I hereby ceril�fy lhal I have read and e�amined this epplication and know the same to be true and correct All provisions af laws end <br />ordinaces governing thls type of work will be comphed with whether speciGed herein ar nol. The qranGng of a permit dces nol Dresume <br />to give authority to violata or cancel the provision of any olher slate or local law regulating construttion or ihe pertormance of <br />construction That I am aulhorized by ihe owner of ihis property to periorm Ihe work for which applita6on is made and I comply with lhe <br />Stale Conlractors Law 1827 RCW and 296.200 WAC. <br />Si3naWre o wned ontractori uthoraed gent ate <br />� <br />