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ERMIT APPLICATION <br />CITY OF EVERETT PERi1AIT SER��ICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FFJC 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM T!� 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS A I <br />y� ��.z.rc �-U..a� <br />LEGA� LOT NO. <br />DESC. <br />TENANT NAME <br />CONTRACTOR <br />IJ�j�ey..lrSr�.n-� ��'�a/�,5��'� <br />CONTR. LICENSE # 1n�j �Y ^ �,�� G <br />o � � �1 <br />USE OF BUILDING <br />�� l c ��-� <br />W RK DESCRIPTION <br />G �c�. c� � ��c� l � <br />� � 5-�� 1 � �l�( <br />PARCEL TAX I.D. # <br />TRACT <br />ADDRESS <br />���i�7 C'-uu�rC�e�w�. <br />� CONTACTFO PERMIT <br />ADURESS <br />�6�i'�t�wY yq So�-��. <br />� <br />HEATSOURCE <br />� <br />3��--�1s�7 <br />PHONE <br />36v - �(�.�(- �3� <br />CITY2IP <br />�����d� <br />�t £3�73 <br />_ Electric _ Gas _ Other <br />��1� S��`.� <br />5��� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basln) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Rooi drains <br />Olher _ <br />PHONE <br />360 - �C2 �I - i3z S <br />CONTRACT PRICE OF WORK <br />SWv� <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 />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />I hereby ceritify 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 lhis type of work will be complied with whether specified herein or not. The granling of a permit does not presume <br />to give aulhorily to violate or cancel lhe provision of any other state or Iocal law regulating construcGon or the performance of <br />construction. That I am aulhorized by the owner of lhis property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 CW and 296.200 WAC. <br />`� ��ti �� ��—�C` ��Z <br />SignaWre of OwnedCo crorlAuthorized Agent Date <br />