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PERMIT QPPLICATION <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAJ( I.D. # PERMIT p <br />� 2Z3 [jrcq�S�.�n 2.$�50 ob301 Oc� J��I <br />LEGA LOT N0. BLOCK TRACT OR SUBDIVISION M <br />OESC. <br />OIWNER \ ADDRESS CITY2IP PHONE <br />�Y�ij% It 5"�' F��l>r-(� 7�Gi ��.. I �CGfr} :�iHr'-I ���ic� llL'i. ��9n..�;. 1���.1 <br />`IS' ) �)'r <br />TENANTNAME <br />CONTACTFORPERMIT <br />PHONE 3 bo ' b � �- -' � � <br />pfls�r'cwN S" 5 Af �'O�u �-�C�tS< I �C�� L�VI 'ic E•MNL �S�.t�'h� nAWv•Ce�*1 <br />q . I I <br />Cu.`:ion. j�asi5., -1-hc. 4..L3 Kt�,i�.<kySF-. ,3ill�.,�y.vnSBt�y 3�c-''�C...�! 50 <br />CONTR. LICENSE N C�1 � k�i C <br />USE OF BUILDING <br />(<+/i0 <br />HEATSOURCE <br />Electric _Gas_Other <br />WORK DESCRIPTION , <br />. <br />�— NiW 1ti�'t�hlA1.1.� ,1-��tin.is.n.+.-.( Awi./��iJ <br />NO. I TYPE OF FlXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shawer <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />W aler heater <br />Sink (service/barlmop/etu.) <br />BackBow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CONTpACT PRICE OF WORK <br />.� 3, yy� `'- <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C —air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />_ Gas fireplace <br />_ Gas range ��°/.� � i <br />_ Clothes dryer � � �r� <br />_ Range hood �� <br />_ Exhaustfan �G <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TA7( CODE IS 3105 <br />1 hereby ceriN(y that I have read and examined this application and know the same to be true and correct. All provisions of Iaws and <br />ordinaces governing this type of work will be complied with whether specilied herein or not. The granting ol a permit does not presume <br />to give aulhority 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 periorm the work for which applicalion is made and I comply with the <br />State Co�tracmrs Law-7$27 RCW and 296.200 WAC. , <br />� (Y <br />