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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTf"D FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # <br />PERMIT # <br />67— <br />ob uc -LEI tA0 <br />LEGA LOT NO. BLOCK <br />TRACT OR SUBDIVISION # <br />DESC. <br />OWNER <br />_ <br />ADDRESS <br />CITY/ZIP <br />PHONE <br />::j0SiEQH <br />LRuc- <br />gda03 <br />aZsi�l�y-� <br />TENANT NAME <br />CONTACT FOR PERMIT <br />PHONE <br />�JC RUOqir-EZ <br />4RACT <br />I tgOiq CRP HJC- NC- <br />E-MAIL <br />CONTR. LICENSE # V S A 9 0� x <br />C�? \ v <br />USE OF BUILDING <br />I <br />HEAT SOURCE <br />I <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION Q 00*r' P 7/ <br />f/ <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Slower <br />Kitchen sink R disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (service/bar/moprelc.) <br />Backfiow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />Electric _ Gas _ Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work Ivill be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or canci provision of any other state or local law regulating construction or the performance of <br />construction. That I am aulhori the owner of this property to perform the work for which application is made and I comply with the <br />Slate CoD¢acfp(�lLew 18.27 and 296.200 WAC. / <br />/i�l/�/// p9/ol�or� <br />