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� <br />f _ <br />`PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRCEf, 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 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. N I PERMITQ# <br />b l{" �� E-Vr�l�(� 1 �f�£.✓ �� I I 0(7 3�� Y U u'{- � ��f'° o S�') iJ� � <br />LEGA LOT NO. BLOCK TRACT <br />p �- 0 i'/h'�-r-�n-S ft� P <br />TENANTNAME <br />PA-�^'^� i�1-11-]-�r-� S <br />� zSs6 �,?�+-�c =��i, wn�Y s �n-rrvF ��B <br />ye�ias <br />CONTACT FOR PERMIT PHONE <br />1 IvA'�S �'ND f�ILwu �(� �1 0 6 _ S��7 -�$ 7.� 7 <br />CONTRACTOR A�DRESS <br />s I�T r+-L c.L.✓E. S i G,� Y R- `^'n' xw6 <br />CONTR. LICENSE # �'J o 1�" ��" ��'ol�t¢ ��� • <br />s I+o u S R N� l Sw c. <br />USE OF BUILDING HEAT SOURCE <br />CITYRJP PHONE <br />� Sli-wt�Lvs+.`ti � wn �a �- <br />7�t3� s�f-�.--��37 <br />G a M r-i. �rLc ri�y-(.. - �L�Tt?�'z�' _ Eiectnc _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />{�- -� S'� o O o � p o <br />�f <br />WORK DESCRIPTION ,,. S7'ai�-E <br />�%N OILI vl-j� 9- T�r� $% N-I.l� i LL�n M cN /�"'7-L4 G I}"YiT�NE I� (. G�7Tt�rZS v <br />�-�✓u �1 D o �.. [s L.� - �ri-�� y �� . PY �. o ry S�-G � `^� � ��.�n�-o�t� /L'`A'D F�iQ „ <br />NO. I TYPE OF FIXTURE OR {7EM <br />Toilel <br />Balhtub <br />Lavatory (wesh basin) <br />Shower <br />Kilchen siiik 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mopletc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floordrain <br />Grease trap <br />Roof tlrains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Olher <br />CITY OF EVERETT LOCAL SALES 7AX CO�E IS 3105 <br />I hereby ceriUty thai I have read and examined this application and know the same to be tnte and coRecl AII provisions ot laws and <br />oNinaces goveming this type of work will be complied with whether specifietl �erein or not. The fl�nting of a pertnil does nol presume <br />to give aulhority to violale or cancel the pmvision of any other state or local law recyulaling construction or lhe pedormance of <br />construdion. That 1 am authorized by the owner of this property to perform ihe work for which application is made and I comply with the <br />Slate Contraclors Law 18.27 RCW and 296.200 WAC. <br />i <br />� ��L/L—/� 5�13��g <br />Signature of OwnerlConiraclor/Authonzetl Agenl Date �/z <br />�• <br />T <br />