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-- � - <br />PERMIT APPI � ;ATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 982�� <br />425257-8810 — FAX 425-257-8857 — www.everettwa.org <br />SITE ADDRESS <br />a �� 1'101 <br />LEGAL LOT HO. <br />�ESC. <br />OWNER <br />I�x? � n�p�1��' <br />TENANTNAME <br />CONTRACTOR � 1n ��m���<' <br />� <br />CONTR. UCENSE R u�i � T�' <br />��.� <br />USE OF BUILDING <br />.'CSic'�r�.�1�t l <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />L c' �l <br />BLOCN TRACT <br />� L LL �i�ns <br />ICON'/TACTFORPERMIT <br />FQ✓ Q �'1 � ( �� <br />�_ I �i�����ry / ADDRESS <br />r�� � <br />-- " CITY2IP <br />pC &�x I�IS� <br />�RMIT M � <br />�,1- Cl <br />PHONE ytS- q,il-I`l-7[� <br />�( st�asg <br />���� �i r �jI�PV�IIt— <br />PHONE <br />3h��- (�7 0?l�_ <br />PHONE ,�0� E�.7�oi 1 �a <br />���, ys ��� ll�e w� 9f3��� C <br />HEAT SOURCE CONTRACT PRICE OF wonn <br />,_ Elednc _ Gas � Other � / cJ � � <br />WORKDESCRIPTION �.( ��`1,,,�.,-,1��c. 'F��< �n.,•,�Ij'- 'y`-�a.� <br />n�•,1�� II n {ir.. <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />BatMub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Smk (servicelbadmopletc ) <br />BackAow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Roof drams <br />Other <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />AIC - air handling untts <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil heater <br />Boller <br />Refrigera6on <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />I hereb ceritity that I have read and examined lhis apphcation and know the same to be true and correcl. All provisions o( laws and <br />Y <br />ordmaces goveming this type of work will be complied with whe!her specified herein or not. The granting of a permit dces no presum <br />to give authority to vlolate or cancel the provision ol any other state or local law regulating construdion or the peAormance of <br />construcUon That I am authoraeA by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 1927 RCW and 296 200 WAC. <br />7� �/�� �7�/ �l r '�-��� I <br />