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�r�ERMIT AF'PLICAT ��N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everetb,va.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />LOT N0. <br />OESC. <br />BLOCK I TRACT <br />PARCEL TAX I.D. # PERMIT # <br />)�9fi7-OCX�-��79ob �>�>���%lj <br />(�a.�..c� - 'tinnr 1,l_L 3 l:c � C�Ib.i Fw '�.::.,fc.� `�SS2G' i `125"'2S"•i'`rcw,o <br />TENANT NAM I CONTACT FOR PEP4SiT PHONE <br />i V:�v�P <br />CONTRACTOR (ZoW;,,�� ��� L,,,,�r"� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />�0+��a� —iftZEO L1. f� <br />4DDRE:.S <br />34� � c..�h,� f3.ti <br />���� 7- o <br />HEATSOURCE <br />'ZS-�LY-33�'� <br />CITY2iP PHONE <br />�JLY.r_C� ���S�ZC+1 �LS 'ZS �/_a�C:u4 <br />� <br />_ Electric _ Gas _ Other <br />�j v_..�•�i-,� I.�o.:�,� S:�¢ <br />UJ.1� Yl��..i ��..,C.i.�Q CG� <br />�C <br />NO. I TYPE UF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />�ishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/b3r/mop/etc.) <br />Backtlow preventer <br />I _ Unnal <br />Drinking Foun:ain <br />Floor drain <br />i _ Grease trap <br />�. Roof dra!ns <br />, Other <br />CONTRACT PRICE OF WORK <br />�IO,er�r� `"� <br />NO. I TYPE OF FIXTURE CP 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 />Exhaustfan <br />Heat pump <br />Ur,it healer <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS .1105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces goveming this rype of work will be complieC with whether specifieA nerein or not. The grantlng of a permit does not presume <br />to give authonty to violate or cancel the provision of any other state cr local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property M perform the work for which application is made and I comply with the <br />State Contractors law 18.27 RCW and 290.200 WAC. <br />� , <br />�. �-'%., , i ��---r""l "� a-3 -�]ao�� <br />SignaWre of Owrter onttactor/Authonzed Agent Date � I <br />Z <br />