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9 <br />R <br />f <br />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 />�l�12.`-OS <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />%� � � <br />LEGAL LOT NO. � <br />DESC ! <br />OWNER <br />J .rw. �� ` � �L _ <br />TENANTNAME <br />COHTRACTOR ��iyy�� � <br />CONTR. LICENSE f <br />USE OF BUILDING <br />Ci <br />cL2 ���ir <br />WORK DESCRIPTION <br />Lc�v}.f.'1,�'.c.[-� !i._ <br />F, PARCEL TAX I.O. # <br />�k=-�-Lt' C�C`5�1 �(. CCL� /� U <br />BLOCK �fiACT <br />�in_.�/ �.�.� (�. , /� X� J��/%w,c.� <br />��1� `15�3u p���:L�,��S���_ <br />CONTACT F PERMIT <br />��'�-�- ��-� <br />ADDRESS <br />� 3r f�:��: L4� ��.� <br />I HEATSOURCE <br />PF./RMIT # i' <br />Y-- <br />_ i� • `��J-�. <br />PHONE <br />��-'�Y7 7;c`i`} <br />PHONE <br />CITY2IP PHONE � <br />4�WL'Z1�-�1. �-2�-,�i�f7'}L9 <br />_ Eleqnc _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />{ �� %C� (! �� � <br />3 (t\h� �-R.�L�1.��...2` R�C�R,c��a�(.' �0 .G�.: L�c+-tvtt <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (servicelbadmop/etc 1 <br />Backflow pr.+venter <br />Urinal <br />Dnnkmg Fountain <br />Floor drain <br />Grease Irap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Golhes dryer <br />Rangehood <br />Exhaus� lan <br />Heat pump <br />Unit healer <br />Boiler <br />Reingeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAl( CODE IS 1105 <br />I hereLy ceritify that I have read and examined this application and know ihe same lo be irue and correct All provisions of laws and <br />oroinaces goveming this type of work wJl be comphed vnth whether speci`ed herein or not. The granting o( a pertnil does not presume <br />tn grve authonty to violate or cancel Ihe prnvision ol any olher state or local law regulatmg construclion or the peAormance ol <br />consiruction That I am authonzed by Ihe owner ol!his proFerty to pe�fortn Ihe work lor vmich appllration is made and I comply wdh the <br />State ConVactors Law 1C 27 RCW and 296200 WAC <br />-���: �-i. '7/�-•��z��as` <br />— > .� �Z <br />