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P�F�I�AIT APPLICATII.N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT. WA 98201 <br />425-257-881 Q- FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />E ADDRESS PARCEI TAX I.D. # PERMIT # �"' <br />�� NCe�-l�1 1�tc�;nDwf��, � 2�foSl%Do2o(3� [� =��G -� <br />;Au �or � _. <br />C.0 l:�t i r <br />TENANTNAME <br />��� <br />BLOCK <br />unn������ a � Y <br />TRACT <br />— 2UU�� <br />C<� c C. �= c�e <br />CONTACT FOR PERMIT <br />Ir(lJ�(�Z- I�t�2rvS <br />�;tSi <br />��2�-3�`��`t2 S) <br />PNONE <br />�� �(Z � -.S�&= �' LS 3 <br />CONTRACTOR � ADDRESS CITYIZIP PHONE <br />�'�lr�. (�1GP`fC r�SC'�� ��{�� ��1 N E 2`i �iy ��AC� �r=L4 ��'C �^'P �-1vcr� 7 <br />CONiR. LICENSE k T 1��� n C I 1 G'1� N l7 �� <br />�v IG- 7�l�c`"7%�7�—%''% � <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />: � �� L1 �:J � (_ ( L `� _ Eleclric _ Gas _ Other �' `1 �i � l� � J <br />WORK DESCRIP710N � <br />�y�,�� L 1�� ��1,rJ �l � �L,1 _1- LJ%{_� �-�Lf\ T F`r1 [� J t-w �Af'-Kt � V <br />L LvZ - SI,Pp�rri� P��z��i <br />S � �� C' � ` �' �Z � — �Y� ( �f � r ��� � <br />NO. I IYPc OF FIXTURE OR ITEM <br />Toilet <br />8alhtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/bar/mop/eta) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />� <br />NO. � TYPE OF FI%TURE OR ITEM <br />A/C� - air handling units <br />Forced air systems <br />Gas pipinc� <br />Water heater <br />Gas fireplace <br />Gas renge <br />Clolhes dryer <br />Range hood <br />Exhausl tan <br />Heat pump <br />Unit iieater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CI1Y OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby cerilify lhat I have read and examined this application and know the samo to be lrue and correct. All provisions of laws and <br />ordinaces goveming this type oi work will be complied with whether specified herein or nol The granting of a permil does not presume <br />to givo authorily to violale or cancel the provision of any olher slzte or local law regulaling construction or lhe performance of <br />construc . Thal i am aulhorized by lhe owner of this property to perform the work for which application is made and I comply with the <br />Stete on actors Law 18.27 RCW and 296.200 WAC. <br />r — — <br />