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P�.r2MIT APPLICATIG�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-N' 10 — 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 />S 2D '�t � <br />LEGA LOT NO. <br />DESC. <br />f1G�� ' <br />°NANTNAME <br />A�� C <br />PARCEL TAX I.D. # <br />TRACT <br />�o�il � l ��ST ScJ <br />CONTACT FOR P RMIT <br />17Fi IC� �O I �-C� � <br />CONTRACTOR 6 'Lpj�}�j� �S ADDRESS <br />G� O+�i-2Ae.�"'�2 <br />CONTR. LICENSE p <br />USE OF BUILDING I HEAT SOURCE <br />IK,Doo2 �Airi��, G4Ge <br />Electric Gas Other <br />WORKDESCRIPTION mE-��� �� �d�� 4�Z� �,E7' <br />NO. I TYPE OF FIXTURE OR ITtiM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Launtlry tray <br />Sink (service�bar/mop/etc.) <br />Back�ow prevenior <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof diains <br />Olher <br />�PE IT# <br />-ni <br />cirnziP PHON��LJ) 7�6 �/S <br />�-0N+mz+QS k7A 9 g02� <br />PHONE <br />'.� � �zy) 3yF� 57.�nC� <br />CITYlZIP PHONE <br />CONTRACT PRICE OF WORK <br />�le�us Idch'� <br />NO. I TYPE OF FIXNRE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />W ater heater <br />Gas Ilreplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstova <br />Qther <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerility that I have read and eramined this applicalion and know the same to be true and correct. All provisions of laws and <br />orrnnaces govermng this rypo o( work will be complied �vilh whether specified herem or not. Tho granting of a permit does not presume <br />to grve authonty to violata or ca el the provislon of any other state or local law regulating construction or the performance of <br />cons 7hat I am authori ed by the owner of this property to peAorm the work for which applicatlon is made and I comply with the <br />SI e Contrac ors Law 1.&?, �'✓�,' and .90.200 WAC. <br />��L <br />