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ERMIT APPLICATi'C)N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />�-i�`?��R-R'Ffi= ��E-�:}rri��'rr�a�o-�.r'r �avv"ddzv�cRuvc.v�c^i— <br />,-���z �; APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />;r A.J <br />SITE ADDRESS PARCEL TAX I.D. # ERMIT # <br />_ __. - --- - - <br />�,�� ;.��, r 4.a . , = r� .�� I _ � �1fZ���'� <br />LOT NO. I BLOCK � TRACT <br />DESC. r I I <br />OWNER a} �, �-�., yc; ���• �3 c" ADDRESS CITY2IP PHONE -...� 2 5 <br />i�i :� J �a'F"c C Cr 1 � �"Z � � -� �7 f tc""`c�'� :S �� �'°' ; � c�� � �U-e.tf' � � � . ,- � i �2 ;r - j Z � �� <br />� � <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />� � <br />\ '- �� `1 2` � �. �... _-'�. 2- <br />_) c,�,'--� 5 ` � - <br />CONTRACTOR <br />,r:s ,�� �N,. �L'., t �'1� ��. r.l.�-:-�? <br />CONTR. LI ENSE # <br />/U a%.� 1 l i�1 ['-j Z�% ,�' <br />USE OF BUILDING <br />7 <br />(.�--� -__r � � =� -� � �. <br />WORK DESCRIPTION <br />S,� S 1-e;�. `� <br />ADDRESS <br />� � �, :� � •..,: 7 r�. S f-- <br />J �` _ <br />' k��� �� � <br />�-, S. ��z._�;� �..� <br />� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />IGtchen sink & disposal <br />Dishwashe� <br />Clothes washer <br />Laundry tray <br />Sink (senrice/baNmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinldng Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEAT SOURCE <br />_ Electric _ Gas _ Other <br />CITYIZIP PHONE '�-j2_s <br />��,,,1'jl L.J`y'.J <br />J�'�_2^ 1"t-.:1 ' f Q.`� ��•� <br />CONTRACT PRICE OF WORK <br />2 ��f � `rJ'� <br />NO. I 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 />Refigeration <br />Woodstove <br />Other <br />CITY OF EVERETT �OCAL SALES TAX 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 this type of work will be complied with whether specified he�ein or nok The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the perfortnance of <br />construction. That I am authorized by the owner of this properiy to perform the work for which applicaGon is made and I comply with the <br />State Contractors aw 1827 RCW and 296.200 WAC. <br />� � /� � l �� <br />Sinnat�,re of Owne ontrac thorized Agent Date � <br />