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/ <br />SIT�E,�AD�DR�ESS , <br />LEGA�LOT � <br />DESC � � <br />�ERMIT APPLICATIt,N <br />CITY OF EVERETT PERMlT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetMa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I,D. p <br />Gri-C-�,� r1P� <br />B� LOCN � TRACT <br />� <br />-� <br />N <br />"�t� <br />" C J <br />_...._�m�n.�.� ,�,� � „. 9.s�5� ���t/E 1ioz (a.F��e+ieicr 9��'� - <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />�r��la I/�i h eJ �7S- -7� �/- / 5 � <br />CONTRACTOR <br />CONTR. LILENSE M 6c �mvN << <br />Ivy6� <br />USE OF BUILUING <br />WORK D SCRIPTION <br />� � �� <br />N0. I TYPE OF fIXTURE OR ITEM <br />Toilet <br />�athtub <br />Lavatory (wash basin) <br />Shawer <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry iray <br />Smk (service/badmop/etc ) <br />Backllow prevenler <br />Urinal <br />Dnnkmg Fuuntam <br />Floor drain <br />Giease tiap <br />Roof drains <br />Olher <br />CITY2IP PHON <br />�- �iZS-�S-� <br />95/5% 5�� iC/�/DZ� �2���f/E/�I <br />.s��o <br />l(�A- <br />HEAT SOURCE CONTRACT PRIL'E OF WORK <br />Electnc ✓ Gas Other <br />I�y;�� 'l <br />N0. <br />TYPE Of FI%'iURE OR ITEM <br />A/C - air handling uni�s <br />Porced air sys�ems <br />Gas piping <br />Water heater <br />Gas hreplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaust lan <br />Heat pump <br />Unit heater <br />8oiler <br />Refngerahon <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TA% CODE IS J105 <br />I hereby centify �hat I have read and ezamined this application and know the same to be true and correc;. All provisions of laws and <br />ordinaces goveming this type ol work will be compfied wilh whether specihed herein or nol The grenting ol a permit does not presume <br />to give authunty �n violale or cancel the pmvision ol any other stale or local law regulallng consirucGon or lhe perfortnance ol <br />construcUon Thal I am authorized by the owner of this property to pedorm �he vrork lor which application �s mede and I comply wi�h the <br />State Co lractors Law 1827 RCW and 296 200 WAC <br />::c� '1 ��� �L��i <br />Sign ture ol w�r/ ontrecror/Authorized Agent ate ( <br />�? <br />