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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES g.. y.-o 7 <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />> �lr .P.cvr�lccv U.]�,E m�e:�c�l7 <br />I.EGAL LOT NO. BLOCK <br />DESC. <br />OWNER <br />�3F_rt,v�rt.ni;n <,ai+<,i���+p _ <br />TENANTNAME <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION N <br />5�1ic• �tever��v cnu� <br />CONTACT FOR PERMIT <br />E4[rtn7 <br />PHONE <br />PERMIT # <br />� 10�� <br />H�s 3i4' �`c�� '+3 <br />J2r�NJ,O�aoiP= �G�•O'.�'nt� I E-MAIL <br />CONTR OR AUDRES CITYIZIP P NE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />i! _t�bq �.:�.n:i�/ llr•,ut:� <br />WORK DESCRIPTION <br />N0. I NPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Ki�chen sink 8 disposal <br />Dishwasher <br />Clothes washcr <br />Water healor <br />Sink (servicelbar/moplr.tc.) <br />Rack(low preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease Irap <br />Roof drains <br />O�her <br />HEATSOURCE <br />Eleclric Gas Olhcr <br />CONTRACT PRICE OF WORI( <br />Np, I TYPE OF FIXTURE OR ITEM <br />A/C — air handlinc� units <br />Forced air syslems <br />Gas piping <br />Waler healcr <br />Gas lireplace <br />Gas ranpe <br />ClMhes dryer <br />Rar�ge hood <br />Exhaustfan <br />Heal pump <br />Unil healer <br />Boilur <br />Retric�eralion <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby ceritify lhat I have read and examined ihis application and know the same lo be lrue and correcL All provisions of laws and <br />ordinaces c�overning this type ol work will be complied wilh whether speci�ied herein or noL The gran�ing of a permit does nol presume <br />to 9ive authority lo violale or cancel the provision of any olher slale or local law regulating construclion or Ihe performance of <br />construction. Thal I am aulhorized by the owner ot this property lo perlorm the work (or which applicalion is made and I comply wilh lhe <br />St2le Contraclors Law 18.27 RCW and 29f.200 WAC. <br />J �. <br />�, » <br />Signalure ot OwnedContraclodAulhorized Agmri Dalo <br />