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r V �RMIT APPLICATI� N <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 />APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SIYE ADDRESS 1 _ - <br />0 3'-� �t11ari%�C I..A.r u�� <br />LEGPI LOT NO. �� BLOCK TRACT <br />DESC. <br />TENANTNAME <br />CONTRACTOR L. /1m�Q <br />��� <br />CONTR.LICEN�SEiI <br />USE OF BUILDING <br />WORK D SC`� � <br />z�� <br />NO. I TYPE OF FI%Tl1RE OR ITEM <br />,� Toilet <br />�Bathtub <br />Lavatory (wash basin) <br />� Shower <br />_� Kitchen sink 8 disposal <br />�_ Dishwasher <br />�L Clothes washer <br />_ Laundry tray <br />_ Sink (servicelbarlmopletc ) <br />Backllow preventer <br />V Unnel <br />� Cnnking Fountai❑ <br />Floor drein <br />Greasetmp <br />Roof drains <br />Other <br />PARCEL TAX I.D. N <br />��t/E �/oz <br />� CONTACTFORPERMIT <br />I�/G�r �Q <br />ADDRESS CITY2IP �� N�� <br />95/� �i� iC/�/OZ� �iE'1��� L/Gd' <br />�C�i � �' <br />U �' <br />PHONE <br />�heJ �15-75�1= <br />6!/A- <br />— HEAT SOURCE I CONTRACT PRICE QF WORK <br />Electric ✓ Ges _ Other <br />NO. I TYPE OF FU(TURE OR ITEM <br />AIC - air handling unAs <br />Forced air systems <br />/ Gas piping <br />Water heater <br />� Gas hreplace <br />� Ges renge <br />J_ Clothes dryer <br />�_ Range hood <br />� Exhaust fan <br />�__ Heal pump <br />Unit heater <br />� Boiler <br />� Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT IOCAL SALES TA% CODE 19 J106 <br />I hereby ceritity that I have read and examined this epplication and know the same to be true and correct. Atl provisions of lews and <br />ordinaces goveming this type ol work will be complled vnth whether specihed herein or not. The grenting of a pertnfl does not presume <br />� to give authonty to wolate or canwl the provision ot any other stete or local law reguleting construction or the perlortnence ol <br />� construction. That I am euthonzed by Ihe awner ol this property to periorm the wvrk far which epplication Is made and I comply wilh the <br />State Coniractors Lew 18.27 RCW and 296.200 WAC. <br />� �- �1- ��,—�— <br />Signature of wnedContractorlAuthonzad Agent at� e <br />