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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />l 3200 CEDAR STREET, EVERETT, WA 98201 fd— U—O� <br />� �� ,� . 425•257-8810 - FAX 425-257-8857 - wwv✓.everettwa.org �� � , ��� � � <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO A PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />DESC. <br />�i .e�,� Zf � � <br />_ LOT NO. BLOCK <br />t <br />5Gn `� D�I�s ��n� ID <br />TENANTNAME <br />PARCEI TAX I.D. # <br />!� �t t5� T)I,Yi � XJ�i ' <br />T�,D "� -� O � � <br />ESS <br />? ei11,� � ��5-Y `1_3 � <br />ACT fOR PERMIT . <br />PERMIT # � � � <br />� /i J % - !�:. <br />� � <br />1 ����-r,�y -c2s <br />PHONE <br />�{25-y3b���r�1 <br />PI10NE <br />� �c�.t �y R�z.rw.( ZU6 -�('i $` L��1 �{ � _ <br />CO TR CTOR ADDRESS CITYIZIP PHONE <br />�-r��san �1oMe�.�r�c. �Am� c�5 v�ne� u25��(��-fv3[�R <br />CONTR.UCCNSEM la�`(YSIiYAih5C..3 <br />USE OF BUILDING <br />� <br />WORK DESCRIPTION <br />.[�71 <br />TYPE OF FIXTl1RE OR ITEM11 <br />Todct <br />Bathtub <br />� Lavatory (wash oasin) <br />� Shower <br />1 Kdchen sink 8 d�=_posal <br />1 Dishwasher <br />� Clothes washer <br />Laundry tray <br />Sink (service!badmop%etc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Rool drains <br />Other <br />HEATSOURCE <br />_ Elzctric �j Gas _ Other <br />�r�jec,� <br />CONTRACT PRICE OF WORK <br />f � ,�,a.� Tr <br />NO. I TYPE OF FIXTURE OR ITEM <br />b� <br />M'C — air hantlhng units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas freplace <br />Gas rarge <br />Ciothes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Und heater <br />Boder � <br />Relrigeration <br />Woodstove <br />Olher _ <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 7105 <br />I hereby cerihfy that I have read and ezamined lhis aFPlicafion and know the sam? lo be true and correct. All provisions of laws and <br />ordinaces gcvem�ng this type of work wtll be compl�ed wdh whether spec�f�ed here�n or noL The granting ol a permit does not presume <br />to give authoriry to violate or cancel the F�ovision of any other ;tate or local law regulating conslruction or the perlormance ot <br />construction. That I am authonzed by the owner of Ihi; property to perform lhe work lor which applicalion is made and I comply with the <br />State Contractors Law 18 27 RCW and 296 200 WAC <br />� �=— -- -- __ _ _ o j ls�a� <br />�Z <br />