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F <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />4?.5-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��I �"L�L,_ �' _— <br />SITE ADDRE3S PARCEL TAl( I.D. # pERMiT N ,�'�, <br />�3� P�,lm�sn� �-a..v�e� � �: ;/��'•%-G ' <br />LEGALI LOT NO. � I BLOCK I TMCT <br />DESC. r <br />�vncn ......�...... .... �.�.. <br />13e� rnon+e }k,��y hts u� qs i y y,�, s� �"�oz �c�s u� <br />TENANTNAME CONTACTFORPERMIT PHONE <br />�rG1t �c I-A-Ue�tjn� (y2S�7S'�-�s8�' <br />CONTRAC70R /1.1,,,,�____/y �y,��s AODRE39 CITY2IP �HONE� <br />I"�LI//«JYVr� '/µ� [� ,!` ���Q. <br />CONTR. LICENSE /13�u�� aN � 9 y�� o �� ",/"'tJ�NG ��ii!�,i�b�f W��C �� 'l <br />/.I�JL o <br />USE OF BUILDING <br />WORK DESCRIPTiO4 <br />P�a��� #20`� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavalory �wash besi�) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwaaher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbar/rdop/elc. � <br />Beckflow preventer <br />Unnel <br />Drinking Fountain <br />Floor drain <br />Grease irap <br />Roof drains <br />Olher <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Elednc �Gas Other <br />� 1�,���- i <br />� <br />TYPE OF FIXTURE OR ITEM <br />AIC - air hanAling untts <br />Forced eir syatems <br />Gas pipiny <br />Waler heater <br />Ges fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Relrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TA)I CODE IS ]106 <br />I hereby cenAfy Ihat I have read end er�mined this application and know the aeme to be Irue end cortad. All provisions of laws and <br />ordinaces goverNng Ihis type ot work vnll be complied with whether specified herein or noL The grantin:� o( a pertnit does nol presume <br />to grve authortly to violete or cancel the provision of eny other ste�e or local law regulating conslrudion or lhe perlormance of <br />construction That I em authorized by the owner of this property ro peAortn ihe work for which applicaG�n is made and I comply with the <br />Slate Conlrectore Lew 10 27 RCW and 296.200 WAC. <br />�D/�a/o(2 � <br />Signature�OwneUContractodAuthonzed Agent � �ete � <br />� <br />