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P�RMIT APPLICATION <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 & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS OPT��NC+912� <br />LOT NO. <br />TENANTNAME <br />BLOCK I TRACT <br />PARCEL TAX I.D. # <br />SurTF 2yov���.���r <br />N�w Yd�K <br />CONTACT FOR PERMIT <br />PHONE <br />� <br />ovr/e,vc�,e.� � i�oN�r� %3 �1irrPHiC�' �-�94-73a 6 <br />CONTRACTOF' AD�RESS CITY/ZIP PHONE <br />('y � s N�.�3'1"/tiG Cd. isv� sdo ��rs r ti�.� Mc,�,�e� 3� -7gk-73a 6 <br />CONTR. LICENSE# /, � r � � T � ^ � } � �fS,^u Z <br />USE OF BUILDING <br />G O rtrr�2u�a- �— <br />HEAT SOURCE <br />_ Electric if Gas _ Other <br />WORK DESCRIPTION <br />i�v5r� �- /Jv�T �✓o,er� U-Q«-�-e-s <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry trey <br />Sink (service/badmopletc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />�� �DO Uo <br />%%�F/ �%S£i�S <br />N0. I NPE OF FIXTURE OR ITEM <br />A/C — air handling unils <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 />Heat pump <br />Unit heater <br />Boiler <br />Refngeration <br />Woodstove <br />Other OrIG � GJo,tlG <br />i..FLi L c_�s_, �/� Fc�SE%S <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby ceriti(y that I have read and examined this applicalion and know lhe same to be true and correct All provisions of laws and <br />ordinaces goveming this rype of work will be complled with whether specifed herem or not The graiding of a permit does not presume <br />to give authority to violate or cancel the provision ot any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296200 WAC. <br />/'% n . /J // ,/ . _ U ._ //_/� L <br />