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PEr2R�IIT APPLICATIO�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 96201 <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 <br />?�% <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />TENANTNAME <br />CONTRACTOR i rLL CC/L1 <br />i2e �'r <br />CONTR. LICENSE i{ ^ <br />fi L <br />USE OF BUILDING <br />BLOCK I TRACT <br />�I'LC�ic Tl. <br />WORK DESCRIPTION <br />�-5-.-, 5-��,G� <br />��" —r�-�S-ta,G� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & r+ispusa� <br />Disliwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop!etc.) <br />Backflow prevenler <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />PARCEL TAX I.D. # <br />CONTACT FOR PERMIT <br />PERMIT q <br />PHUNE <br />ADDRESS CITY2IP PHONE C�-3� !l-2 <br />?�s��ci ��'-�-h �v�s ��� <br />Aulz„-r . <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />�� <br />_ Eleciric '�Gas _ Other ��-D �.—_ <br />:ze� ,S`?"n-n A-/ C a� h cetf�r, <br />G--�as �; P � . <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 />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Waodslove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby cerilify Ihat I have read and examined this application and know the same to bo true and correcL All provisions of laws and <br />ordinaces governing this lype of work will be complied wilh whelher specified herein or nol. The granling of a permit does not presume <br />lo give authori�y to violato or cancel lhe provision of any other stale or local law regulaling construclion or the per(ormance of <br />consWctioqll'hat I am authorized by the owner of lhis property to perfonn lhe woik for which application is made and I comply with lhe <br />Stale CoratFactors Law 18.?,7 RCW ancyR96.200 WAC. <br />--.J-v" �— p .i` <br />Date � /�a <br />