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PEKMIT APPLICATIOIv <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evereltwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS�S2 (� E✓liLS'!'��'7 ��"J '� PARCEL TAX I.D. # <br />u <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />�/ ) n.lf �/�U `�O <br />TENANTNAME <br />. b. _ ,' INi <br />BLOCK � TRACT <br />C cc,rS �'1 <br />CONTRACTOR 5�,�-jT(� SI CzNS <br />CONTR. LICENSE N <br />,. i . �-.-r C i� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />Wo3�o N1�SSiot�1 13 <br />CONTACT FOR PERMIT <br />�'� ! h��l.l`/EI�/ <br />ADDRESS <br />a�Ul IfE �Z�" <br />'�,-, ��, w � � ! <br />3 —�Z"°7 <br />PERMIT # <br />03 ` <br />.� �c�7 p' - G�Ga <br />PHONE <br />� - ��25� 'SO 8`- 8 �� <br />PHONE <br />S .�o ' I a-- � <br />CITYIZIP PHONE <br />Sf (Zb�� <br />I — HEAT SOURCE CO,NTRACT PRICE OF WORK <br />ElecUic _Gas Olher F� 3� (� � O,� <br />i`�� �1�n v� o�L_l.Lv2� �-^'"�' �-2-'1 V�.e�,.n v�0.h.- �(..'�PN i �-l.wC <br />� V�`i e� . <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BalhWb <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishw�sher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Backilow prevenler <br />Urinal <br />Drinking Founlain <br />Floer drain <br />Grease lrap <br />Roof drains <br />Olher — <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />Forced air systems <br />Gas piping <br />W ater heater <br />Gas fireplace <br />Gas ranc�e <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Reirigeralion <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TlJC CODE IS 3105 <br />I hereby cerili(y that I have read and examined lhis application and know the same to be lrue and correcL All provisions of laws and <br />ordinaces c�oveming lhis lype of work will be complied with whelher specified herein or not The granling of a permil does nol presume <br />to give authority lo violal� or cancel lhe provision of any other state or local law regulaling conslruclion or the pedormance of <br />consirucfion Thal I am aulhorized by the owner of Ihis property to perform Ihe work for which application is made and I comply with lhe <br />Slale aContractors Law 18.27 RCW and 296.200 WAC. <br />! ��_ �{ %Z U <br />Signalure o OwnedCo lr tor/Authorized Agenl Dale <br />'�v <br />