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PERMIT APPLICATION <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 />SITE AUDRESS <br />� `�-� Q¢-� O <br />LEGA LOTNO. <br />DESC. <br />OWNER <br />�,I vY\0�'1'T� <br />TENANTNAME <br />CONT(UCTOR Un'�mi /- <br />CONTit. LICEN8E f ��Nts�� � I <br />USE OF BUILDING <br />�'YSi c�a v� 41�� I <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />PARCEL TAX i.D. # <br />BLOCK I TRACT <br />ADDRE39 <br />ie'-�'1+S � �� 9`il; <br />� I CONTACTFORPERMR <br />/ ADORESS <br />Po �.,x r�i5"7 r�v�a�y� � ll� w�- 9Ba� o <br />th <br />aOf ��P �l <br />"' ` " CI'TYRIP <br />PERMIT M <br />� b� - 7�, <br />PHONE �/[S- 'j d l- �M7D <br />�( 98asg <br />�IOaZ � s/ �PUPH� _ <br />PHONE <br />360 - G57- � l8 � <br />PHONE �7,(p�-(�$ ]v118p� <br />HEAT SOURCE I CONTRACT PRICE OF Wofcrc <br />�7[� 00 <br />Eledric _Gas_Other � / OQ <br />WORKDESCRIPTION �,.����r sy6{o.o+--� <br />i�..s1«IloiioV. oC a�te,,..u1YL �+':t sr• <br />NO. I TYPE OF FIXTURE OR 17EM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Laundry iray <br />Sink (servicelbarlmopletc.) <br />Backflow preventer <br />Urinal <br />Dnnking Fountaln <br />Floor drein <br />Greasetrap <br />Roof drains <br />Other <br />NO. <br />TYPE OF FIX7URE OR ITEM <br />AIC - air handling unils <br />Forced air systems <br />Ga�, piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Baler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TA%CODE IS 7706 <br />I hereby ceritity that I have read and examined this application and know the same to be true and conect. All provisions of laws and <br />ordinaces goveming this type of work will be complied with whether spedfied herein or rwt The grenting of a permit does rat presume <br />to give authority to violate or cancel the provision of any other state or local law regulaling construc4on a the peAormance of �th the <br />construdion. That I am authorized by the owner of Mis property to peAortn the work for whidi application is made and I comply <br />Slate Contractors Law 1827 RCW and 296.20q WAC. <br />�l ��; �-t�, .� /r� /� `� z <br />SionaWre o wnerl ornrador ytFforacW Agenl w�r <br />