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P�,Zf�IIT APPLICATIO�J <br />CITY OF EVERE7T PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 —�wwv.everettwa.org � <br />� /�U ��7 � C�- ,_-), _� <br />APPLICATIONS ARE 4CCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />S�TE ADDRESS <br />� I�'� <br />.EGAL LOT NO. <br />)ESC. � � <br />A r ��. <br />TENANTNAME <br />PARCEL TAX I.D. # <br />BLOCK TRAC� <br />c. lo�:�►, <br />ICONTACTFOR <br />�P)ERMIT# <br />00 .iDV l� �>ii -;�lr <br />;il7p, Sr ►2e�-o� -,y <br />cinrziP PHONE p �, , <br />, � �f US�oy y78� 4,SY <br />PHONE <br />CONTRACTON ADDRESS CITY2IP F'HONE <br />A�� ibClr •, �-ibr��ES L,c. �oia i��«�rcr» W�� �u��.r��t�yS�oy :�C(., • Y7S'• (v`��/7 <br />CUNTR. LICENSF p <br />I USE OF BUILJING <br />_11E�1��� <br />WORK OESCRIPTION <br />I <br />NO. I <br />t �� �. 'Y <br />HEA7SOURCE <br />_ Electric � Gas <br />��l'� , i,'l� l' � �: ,r�'-_� �-I l.i�`. <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />_ Bathtub <br />Lavatory (wash basinj <br />Shower <br />! Kitchen sink 8 disposal <br />Uishwasher <br />Clcthes washer <br />Laundry tray <br />Sink (servicelbar/mopietc.) <br />Backflow prevcnler <br />Urinal <br />Orinking Fountain <br />Floor drain <br />Grea:e trap <br />Roof drains <br />Other <br />CGNTRA�;T PRICE OF WORK <br />Other <br />N0. � TYPE OF FI%TURE OR ITEM <br />A/G - air handling unils <br />Forced air systems <br />/ Gas piping <br />= Water heater <br />/ Gas fireplace <br />� Gas renge <br />—% :lothes dryer <br />�Fiange hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby ceritfy that I have read and examined this applicalion and know the same to be We and correct. All provisians of laws and <br />ordinaces governing this rype of work will be complied with whether specified narein or not. Tiie grenting of a permit does not presume <br />to give authonty to violate or canr,el the F rcvision of any other state or local law regulating conswction or the performance of <br />r,onstruction. That I am authonzed by tne owner of this property to perform the work for which application is made and I comply with the <br />State Contracrors Law 18 27 RC's! ana 296.200 VJAC. <br />S�gnature of OwnenContractor;Authonzed Agent Date �/ ' <br />