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I��RMIT APPLICATIC,�� i ,, �, <br />CITY OF EVERETT PERMIT SERVICES I� �° <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FA� 42�-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADORESS <br />333o M� ' <br />LEGA LOT NO. <br />DESC. <br />� <br />Hve 00 <br />BLOCK TRACT <br />PARCEL TAX I.D. # <br />r . <br /># <br />�Q� <br />�(to5. {�i�on�to�c. LLC 7f7 So. �qY.drR 5�. Senaf�c 9813�/ <br />TENANT NAME CONiACT FOR PERMIT � PHONE <br />SRfil.eil j11F6. Cc. I��Ahe ilini'oh 360 -651 -��o� <br />CONTRACTOR, ADDRESS CITY2IP PHONE <br />SM�+� ��Re Sy5'�cn5 3i3�3 �%�TS J+.Y�7.E'. <br />CONTR. LICEvSE p _ <br />USE OF BUILDING <br />WORK DESCRIPTION <br />5�,+� <br />HEAT SOURCE <br />_ Eloctric _ Gas _ Other <br />F,aa SP2;�ul... Sys-��•., � 24s �ends� <br />TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Oishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mopletc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />a3 36o-G5� •��o� <br />CONTRACT PRICE OF WORK <br />35,y�,s � <br />NO. � 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 />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />qTY OF EVERETT LOCAL SALES TAX CODE IS 3�05 <br />I hereby ceritify that 1 have read and examined ttiis application and know the same to 6e true and correct. All provisions of laws and <br />ordinaces governing this rype of work �vill be complied �vith whether specifed herein or noL The granting of a permit does not presume <br />m give authonry to violate or cancel the provision of any other state or local law regulating consiruction 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 />Slate Contractors Law 10.27 RCIN and 296.200 4VAC. <br />' � ' ir-a4-oy <br />1 J �.an-�0-.� �� �t�,.Acn— <br />Signature of OwnerlContractonAuthonzed Agent Date �/� <br />