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� <br />� <br />PERMIT APP'LICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS S-f ��1��� PARCEL TAX I.D. # PERMIT # <br />,- 3v �% r��: 2;�� ,.,� �r���- � �,�,� Z. � v � � Z- �� r� _3 �� 1 ��� � � � (� �� - �� <br />LEGAL LOT NO. � BLOCK TRACT OR SUBDIVISION # <br />DESC <br />OWNER ADORESS CITY/ZIP PHONE <br />� LL- L-v'��✓L(.%'� (,��G f(o Z' U U�/� ��� S� i�'J Sr �r-E 7�� Z v r SG �TiT�'� tni fl �� I <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />�� �z��-� L`� 3 Z-1 ��-- <br />� v k/� ��:.p (h u C.`�IL% E•MAIL -{- q v 1-c'-✓1 � C�v"G%r� <br />..,_2 s!w <br />CONTRACTOR DDRESS CITYlZIP PHONE � � <br />� (ZC�4-1 i: (L Cc;� �(•� ; �n ��-��:r,}� ..� � S S S � Z�(c`� ��r ,L� (� iv T- v✓A �Z�� 3i � � �. <br />CONTR. LICENSE #� n�� � � �l � � p � J� �� 3 Z �j �" Z <br />t` <br />� ZLZ <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />Electric Gas Other <br />WORK DESCRIPTION ��'��'����� <br />�� o• F� ��� �U��2i-� � a D �, /'�� � "�� ,� 1��=�'C s c <br />"rL ,� �. � : �� o c ;�r� ,.N �� ►n� � %� q-ti �� wA-�� ��4--,� � � �T . <br />ING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/rnop/etc ) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />� ��':�N�L�I� <br />NO <br />► I�a;►_1�II�7_L <br />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 />Ciothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be true and correct All provisions of laws and <br />ordinances governing lhis type of work will be complied with whether specified herein or not The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or locai law regulating construction or the performance of <br />construction That I am authorized by the owner of this property to perform the work for which application is made and 1 comply with the <br />State Contractors Law 18 27 RCW and 296.200 WAC. <br />� � <br />;� � - � ��3� l�- <br />Sianature of Owner/Contractor/Authorized Aqent Date <br />�� <br />