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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425257-8857 — www.e�ven:riwa.urg <br />APPLICATIONS ARE ACCEPTED FROM ? i►M TO 4 PM <br />SITE ADDRE33 <br />LEG � OT NO.� I � BL K I <br />DESC. <br />OWNER <br />�-� mOn�E iiQl G�'1 <br />7ENANTNAME � <br />coNrRncroR Un�irn,iEr /1 Qc aN, <br />CONTR. LICENSE � UNLIJ� MI� 3M <br />USE OF BUILDING <br />✓r:�i �o r fia l <br />WORK DESCRIPTION <br />� <br />PARCEL TAX I.D. / I PERMIT A <br />f �u ; � � -�r a <br />TitACT <br />+� st <br />/-/Y70 <br />9gasg <br />CONTACT FOR PERM�T PHONE <br />14,-e�, �'l�iz����" abo�-G57-o?18a. <br />� nooaess - -- - cmmv PHONE 7�r0- bS J'� I ga <br />Po L�x i�i5 � r�a�y5 �; ll� w� 9Ba� o <br />HEA7 SOURCE I CONTRACT PRICE OF WORK <br />Electric Gas ✓Other � % SQ o—`� <br />Ih6�y �� � flOv� Cf1 UJ`omG�l�C_ ��r � �p. i'.�k.I�e r �6�Q �� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry Iray <br />Sink (service/barlmop/etc.) <br />BackBow preventer <br />Unnal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. � TYPE OF FUITURE OR ITEM <br />A/G - etf hentlling Un1t8 <br />Forced air systems <br />Gas pipirg <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Ezhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Rehigeratlon <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TA%CODE IS ]106 <br />I hereby centity that I have read and examined Ihis applica6on and knaw the same to be irue aM correct. All provisims of laws and <br />ordmaces goveming this type ol wwk will be complied with whett�er specified herein a rwt The grantlng of a permit does not presume <br />to give autbonty to violate or cancel the provlsion of any other state or local law regulating consWGion a the performance at <br />consiniction. That I am autha¢ed by the owner of this property to perfortn the wqk for yfiich application is made and I comply with ihe <br />State Contradors Law 1827 RCW and 296200'Q/AC. <br />//�,. /%/� �// �./ �( ��C.-, 1����% <br />SlanaWre O�Wf1P�nnirar�nN u�vM nnN ,'—TT— <br />