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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES �_ �,� 7 <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org� `l,l � n� -` <br />I <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />ADDRESS <br />LOT NO. <br />DESC. <br />BI.00K <br />PARCEL TAX I.U. lt <br />�.L���l� ) (� �/ <br />` . � ( �! _l..L,'il <br />TRACT <br />'._`'�'I <br />C �'UF <br />f 1t \ <br />I.� ` �L <br />fi�. [ i� 5 _ <br />OWNER ADDRESS CITY2IP PHONE L'��kN�..�.iv <br />I-lC�.l 1 �l\t i (c��'�..• 1G.•S�`' ��i �.!t.�� �t1 1��� >"1��Nlut.ti�F �t��'?t'2 <br />TENANT NAME � � CONTACT FOR PERMIT PHONE <br />��fi� (�,xE�� E:�=,�,��.���s+1 M�K-rz u.�N�c.t:rv �-z�. -x-�. �Zy2 <br />CONTRACTOR � -�, ADDRESS CITY2IP PHONE �}-�`-�-. ����� <br />n���n�c� �_rsz�..rzuzv� K->:��, i.��"�a��Z �r <br />CONTR.LICENSE+1 ����INFS�k�L�, t'�R� C'� UN'1Tc�5�i'� '�1'O�ht�tiC; �A'OSZ <br />USE OF BUILDING <br />�:t: �;CA �:1',lt� � <br />WORK DESCRIPTION <br />HEATSOURCE <br />U i�'k w: 7v r- <br />_ Electnc _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />� •� �� <br />— ' — — <br />�i�,���F� "�ie�rlt, r"�f�=,� ��f �;i- ��t�_ �i� i��.Pz , I�lcw�i�1C� 1�-'t'�- :T�tS� �E��r=S <br />p�i' �i`: q iE't_ ��� ('���'C��S�tr.� IZ�rloJtz.v (kc��P�-� �/��Zlt�; fLa��l(-y�iC7�i: <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />BalhWb <br />Lavatory (wash basln) <br />Shower <br />�IUtchen smk 8 disposal <br />Clolhes w�l�r <br />Laundry trey \ <br />Sink �serncelbadm <br />Backllow preventer <br />Urmal <br />Drinking Fountain <br />Fbor dram <br />Grease irap <br />Rool drains <br />Other <br />NO. I TYPE Of FI%TURE OR ITEM <br />AIC - av handling units <br />_ Forced air systems <br />__� Gas piping <br />Water heater <br />� Gas fireplace � <br />_ `Gas range � . <br />_ Clo�hes dryer � � ` � <br />Neat pump <br />_ UnA healer <br />_ Boder <br />Refngeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAl( �ODE IS J705 <br />I hereby cenhfy that I have read and examined Ihi; appliwtion and know the same to be true and correct. All pmvis�ons of laws and <br />ordinaces goveming this type of work wtll be complied with whether specified herein or noL The granting of a permd does not presume <br />to give authonty to violate or cancel the provision ol any other state or local law regulaling construction or the performance of <br />constructwn. That I am aulhor¢ed by the owner of lhis propeny to perform the work for which appllcation Is made and I comply with lhe <br />State Contractors Law 18 27 RCW and 296 200 WAC. <br />... , /' <� `YC <br />SignaWre o( OwneUContractor/Authonzed Agent Date �' <br />:� . 2 <br />