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P�RMIT APPLICATI(�N <br />Ci"fY OF EVERETT RERMIT SERVICES <br />3200 CEDAR STREET, tVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SIT�= .40DRESS <br />�:'10�.� � <br />LEGAL lATNO. 3LOCK TRACT <br />DE ;C. _ <br />OWNER A�DRE <br />j�.� C'�'lc� r..� h <br />PARCEL TAX I.D. # <br />TEN���E '� CONTACT FOR PERMIT <br />. \ <br />\J <br />CONTRACTOR ADDRESS <br />AN�1 LP�.�S "}{�\/"f I��S `LfS'`[5 Zg0 'T�'I �'-'{� �KS <br />CONTit. LIC[IJSE # /� Q«./1�'� Lt"I�[�` �� �"1 <br />,, , <br />USE OF BUILDING <br />HEATSOURCE <br />LY'.=�. � <<S <br />PE # <br />i' � � <br />� <br />PHONE O� <br />PHONc <br />i�C�ilTMwo..Q Wq-Ptiq.�S3 <br />C-�4z5) •y I�-3$61i <br />Eleclric Gas Othcr <br />WORK DESCRIPTION <br />�'- i h.l�c,� � v�� µ t� <br />� <br />PLU <br />TYPE Of FIXTUR[ OR ITEM <br />Toilel <br />Balhlub <br />Lavalory (wash basin} <br />Shower <br />Kitr.hen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry Uay <br />Sink (service/bar/mop/et�.) <br />Bar.kflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher __ <br />NO. <br />CONTRACT PRICE Of WORK <br />, OD <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler healcr <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Rangr,hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Relrigeration <br />Woodstove <br />Other_ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y lhat I have read and examined this applicalion and know the same to be true and corrar.L All provisions of laws and <br />ordinaces governing th's type of work will Le complied with whether speci(ied herein or noL "fhe granting of a permit does not presume <br />to c�ive aulhority to vio te or c� ncel the prc�vision o( any other state or local law regulaling canstruclien or Ihe performance of <br />wqstruclion Thal I a'aulhor ed by lhe ca✓�er of this property to perform the work for which applicalion is made and I compty wilh the <br />StAtc Conlr�tors La� '1827 CW and 29�i.209 WAC. <br />"17^� <br />