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� <br />PERMIT APPLICATION <br />CI'TY OF EVERETT PEF�MIT 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 & CREDIT CARDS ARE NOT ACCEF'TED <br />SIT� ADDRESS OPT/ON49P E <br />LOT N0. I BLOCK � TRACT <br />DESC. <br />TENANTNAME <br />PARCEL TAX I.D. # <br />S ur rf 2Yay "" """ <br />N�� Yo�K <br />CONTACT FOR PERMIT <br />PHONE <br />� <br />oor/eNcft� � .�oti�u� %3 11itiPHit�Y .� ?`14-?3a 6 <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />�y �,S N�/NG Gd. /NG soo ��-s r y�sr.v Mo,u,te�. 3r,o -7�ry-73d 6 <br />CONTR. LICENSE # /, � L c✓� i r � A'7 )(\ q�� Z <br />USE OF BUILDING <br />G O /"Irr�2Gtra- �- <br />HEATSOURCE <br />_ Electric .� Gas _ Other <br />CONTRACT PRICE OF WORK <br />�QO U o <br />WORK DESCRIPTION <br />�,�ST��- i.�v�-r r✓��er� �r�r��s !�v ,D�F�vs�,�s <br />PLUMBING <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Greasetrep <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hocd <br />Exhaustfan <br />Heatpump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other OdG � C.Joif(G <br />C.,R✓L�@'s�� �/GFc�sE.�.S <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerili(y that I have read and examined this application and know the same to be true and correct All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authoriry to violate or cancel lhe provision of any other state or local law regulating consUuction or the performance of <br />construction. That I am authorized by the owner of this property to perform lhe work fcr which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />�� n . /J // / _ _ �i .- //_i� C� <br />