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PEFciNIT APPLICATIOIv <br />CITY OF EVERETT PERMIT SERVICES 1 /_ ;; I <br />3200 CEDAR STREET, EVERETT, WA 98201 �jt, ��w <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />�G ) �S-� <br />APPLICATIONS ARE ACCEPTED FRCM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTE(J <br />SITE ADDRESS <br />' S ��ux,�.:.�. �1.: <br />LEGAL LOTNO. . BLOCK <br />DESC. <br />OWNER <br />, <br />TENANTNAME <br />CONTRACTOR <br />��c�' o�1L_ �. n �:.� � 12 ��, �5 � 1_ �. �` <br />CONTR. LICENSE # <br />la �11T k�� ��:�',.: <br />USE OF BUILDING <br />TRACT <br />I�n <br />PARCEL TAX I.D. # <br />y ;>o^� � isa <br />; 'L�1 \7�t-v..-�1J..� <br />11��� • ����� ��u��F <br />CONTACT FOR PERMIT <br />L.�tJ �-- t' SS I�.� <br />ADDRESS <br />i* <br />l li��� 'Ss" �1�� �C <br />HEATSOURCE <br />o..L1` � r(:i , 1 G <br />� <br />4��i j �J, ?� -( l l <br />PHONE <br />�1a5 ' 'i V 3.- �'l IB <br />CITY2IP PHONE <br />���\i�U `l'b�i? V�� - 1`t � - �l lk <br />�, \ _ _ I _ Electric ✓Gas _ Other i <br />Yl�_a.N-Ss��, i <br />WORK DESC IPTION BONUS ��o►-i <br />' }. 4�-r- �sL+�. 1'� �;.�+v-.�Sc.�1 .s..:.w�`' L�.tZu-4s � t�:� <br />�;.�� _,ti,���.,.��:z� -,��'J �� � S � i _,-�� <br />PLUMBING <br />NO. I NPE OF FIXTURE OR ITEM <br />(b Toilet <br />� BathluU <br />� � avato�� (wash basin) <br />Shower <br />_;� Kitchen sink 3 dispos2l <br />�d_ Dishwasher <br />1. Clothes washer <br />� l mdry tray <br />Sink (servi:elbadmop/etc.) <br />Backflow preventer <br />Urinal <br />Orinking Fountain <br />_ Floor drain <br />Grease trap <br />T Roo( drains <br />%r� Other <br />CONTRACT PRICI= OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />rVC — air handling unils <br />� Forced air systems <br />� Gas piping <br />•� Water heater <br />_� Gas fireplace <br />_� Gas renge <br />� Clolhes dryer <br />_� Range hood �ti cq,; <br />�_ Exhaustfan <br />Neat pump <br />Unit heater <br />Bailer <br />Re(rigeration <br />bVoodstove <br />_ Other_ <br />CIN �F EVERETT LOCAL SALES TAX CO�E IS 3�05 <br />� <br />I hcreby ceritify that I have read ard examined this appliwticn and know the same to be true and correct. All provisions of (aws and <br />ordinaces governing this type of �,vork wlll be complied with whether specified herein or not The granting of a permil does not presume <br />to give authority to violate or cancel the prov;sicn of any other state or local law regulating conswction or the peAormance ot <br />construction. That I am authorized by the owner of this property ro perform the work for which application is maoe and I comply wilh the <br />Slate Contractors Law 1E.27 RC`N and '290.200'NAC. <br />��Z <br />