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�NERMiT APPLICATIuN <br />CITY OF EVERETT PERMIT SERVICE5 <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPT�ED FROM 8 AM TO 4 PM ,��; J L <br />SITE ACIDRESS � 1 <br />��J��� 1 iPJ <br />LEGAI. LOTNO�, / BLOCN <br />DESC �F� <br />OWNER � L j <br />�1.4 <br />TENANTNAME <br />CONTRACTOR <br />CONTR. <br />PARCEL TAX I.D. # <br />TRACT <br />-, � <br />-: � <br />� -- � - �'� ���uE �oz (.a�S�eve�r 9��s".� �- <br />CONTACTFORPERMiT PNONE <br />�l'8tf��2la �2/�iheJ �ZS-75y_-/S� <br />L. nm ._� Yn f� .�t ADDRESS v CITY2IP �'P�ON�� <br />f lY,f' 0 /t.�� �v� •�_C,3— �a <br />U1��7N���1S/IZD �IS/5� ��iC/�/D� �'��/E�tJ' <br />USE OF BUILDING <br />WORK D SC� RIPTION � <br />�(1:6�e� o'�� <br />N0. � TYP[ OF FI%TURE OR ITEM <br />�� luilCl <br />,� Balh�ub <br />_�_ Lavatory (wasn basin) <br />! Shower <br />_J� Nitchen sink 8 dispusal <br />/ Oi,hwasher <br />� Clothes washer <br />_ Laundry iray <br />__ Sink (cerv¢e/badmop/etc ) <br />BackBow preventei <br />Unnat <br />Drmking Pountain <br />F loor drain <br />Grease Irap <br />Rool drains <br />Olher <br />��- <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electnc ✓ Gas Other <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling unAs <br />Forced eir systems <br />Gas piping <br />Wator heater <br />Gas fueplace <br />Gas renge <br />Cblhes dryer <br />Range hood <br />Exhaust lan <br />hieat pump <br />Unit heater <br />Boiler <br />Reingeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TA7( CODE IS J105 <br />I I hereby ceritity that I have read and exemmed this apphcation and know Ihe same to be true and correct. .4i1 provisions of lavrs end <br />ordinaces governing this type of wurk will be compGed wi�h whelher specdied herein or nol The granting of a permit does nol presume <br />to gwe a�thority to wolate or cancN Ihe provision ol any other s�ate or local law regulatmg consiruction or lhe pertormance of <br />construction l�hat I am authonzed b� ihe owner ol this property to pedorm ihe work lor which epp6:ation �s metle and I comply wi�h lhe <br />I State Contraptors La 1827 RCW and 296.200 WAC <br />' ,� 4-��� 1 ,�" i!` � L� <br />SignaWre of Owne C ntractorlAulhorized Agent �ate <br />