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�— <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />37.00 CEDAR STREET, EVERETi , WA 98201 <br />425-257-8810 - FAX 425-257-8857 - wwv.�.everethva.org <br />_ APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM go� o a-oo3 <br />SITE AODRESS � pARCEL TP.X I.�. # I PERMIT p <br />LOT NO. <br />DESC. <br />QC <br />TRACT <br />�, � <br />TENANTNAME CONTACiFORPERMIT <br />��.'c �"u��ec'�� S� .�., ;-j- a I%�I � LV �VI'1�1 i C. V <br />CONTRAC R /���,,,r.`''1�ec��,, jIQ`.,`pDDRESS <br />� � � J <br />CONTR. LICENSE # <br />USE OF BUILDING <br />C�TY21P <br />� [. . -1 `'�L;O I-i��� de �c'� � fZ�� <br />i�:� r�/NLv77� i�t <br />HEATSOURCE <br />PHONE <br />�-/2 h - % 7 (c' ' O 13 j .` � <br />PHONE <br />. Lw�.�e�it', Wc� ����n� <br />�%Z.�-� /�,-' ",)], j� <br />CONTRACT PRICE OF WONK <br />I _ Eleclric _ Gas _ Olher I� 3 O, ���. �' � <br />WORK DESCRIPTION <br />Z.aStc�II ��) 5<.i' o� C��uv+rit� jei�e.+'S� �I) L� l� C.c�S`'�%�� L��h,�iet <br />(� ) � i= i� <br />rne.5�c,�� c�evitef <br />NO. I TYPE OF FIXTURE OR ITEM <br />Tailet <br />8athtub <br />Lavatory (wash basin) <br />Shawer <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (servicelbadmop,�etc.) <br />Backflow preventer <br />Urinal <br />Drinking Foun�ain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handGng units <br />_ Forced air systems <br />Gas pipin� <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />qTY OF EVERETT LOCAL SAL[S TAX CODE IS 1105 <br />1 hereby ceritify that I have read and examined Uus application and know the saT� to be true and corred. All provisions of laws and <br />ortlinaces goveming this type o� work will be compl�ed with whether specified heiein or not. The grarting of a permit does not presume <br />to give authorily to violate or cancel the provision of any other state or local law regulating construction or the pertormance of <br />construction. That I am authorized by the owner of this property to pertorm Ihe work for which application is made and I comply with the <br />State Contractors Law 1827 RCW and 296.200 WAC. <br />��-:., l��--,-�i ;� � �'3 1 ��[ <br />S nature of Owner/ContractodAuthonzed Agent Da� �/a <br />