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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEOAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-6857 — www.everettwa.org <br />APPLICA710NS ARE ACCEPTED FROM 8 AM TO 4?M - DEBIT 6 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRES3 <br />fv019 C �.P <br />LEGAL LOTNO. <br />DESC. <br />OWNER <br />Slk,� n M <br />7ENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE M <br />USE OF BUILDING <br />G CZ • <br />WORK D� <br />BLOCK <br />TRACT <br />PARCEL TAX I.D. M <br />PERM�T R <br />�Tc�y(� �0l9 Lc�6� �r;°. Fvrrc(� VS�2Cs i`lzf�3Y�'-E653 <br />�CONTACT FOR P RMIT PHONE <br />`�'�-}}� rJ'= j-i f� J��_ ',��r ;f+'�-�-�-_ <br />i��-�< L ���. <br />NO. I TVPE OF FI%NRE OR ITEM <br />Toilet <br />Bathtub <br />Levatory (v26h basin) <br />Shower <br />Kitchen sink 6 disposai <br />Dishx2sher <br />Cbthes xasher <br />:aundry tray <br />Smk (servicelbar/mop/etc.) <br />BackNow preventer <br />Unnal <br />Drinlang Fountain <br />Floor drain <br />Grease trap <br />Roofdrdine <br />Other <br />ADDRE55 <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />NC1. <br />� <br />raY:lrtl�• •1.L•7;L <br />CONTRACT PRICE OF WORK <br />NPE OF FIxNRE OR ITEM <br />A!C — air hendling units <br />Forced air systema <br />Gas pipmg <br />VJater heatar <br />Gas fireplace <br />Gas renpe <br />Cbthes dryer <br />Range hood <br />Ezhaust tan <br />Heat pump <br />Unit heafer <br />Boiler <br />Refngeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3106 <br />I hereby cenUfy that I have read and examined this appliption aM know the same to be We and coved. All prowsbns of laws and <br />ordinaces goveming this type of work vnll be complied wRh whether specified herein or not. The granting of a pertnit dces not preaume <br />ta give authority �o violafe or cancel tne provision of any ofher state or local law regulating construction or the perfortnante of <br />consUuction. That I am authorized by the owner of this property to pertorm the work for which application is made and I comply with the <br />State Contradors Law 78.D RCW and 296200 WAC. <br />