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PE{�1MIT <br />APPLICATIO�� <br />CfTY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — w�row.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # P MIT # <br />I�-6Z ��c �.►��� �� MAI.L �Uf+y �3 �a�����- �D ,-�-5 <br />LEGA LOT N0. <br />DESC. <br />OWNER <br />S7E�a- 9 f=As i <br />TENANTNAME <br />T� P �(�IiLS <br />BLOCK <br />14�'L <br />TRACT <br />S E F_ v E�G i T M fl i�- �v�+>- � <br />CONTACT FOR PERMIT P <br />I<��vjN C. �i�-i (4�S) 2l0 <br />CONTRACTOR f U N�1 C G CNG�"�/� L��..q��� � Z L <br />L � <br />CONTR.LICENSE# L�/�'�l SQ-'t�dOG �. I� � <br />USE OF BUILDING ��,��} l � <br />�� f/�iL <br />S�- <br />1��„ CITY/ZIP PHONE <br />i3 `�- � r�L� �v���� � y�zoy <br />-: vs�-Y,vL <br />HEATSOURCE <br />>' Electric _ Gas _ Other <br />WORKDESCRIPTION M+i�'L "�p F)�C�'L�'1� SP.f}�-E. 4JV'C L�.tiitiPJCT�I r0/�J_S"�(�-�J_ F%�=�� <br />i��`>i C-u��'^ ." FAi,�/�L ILUc��n .� S�v���iCrE Kr�M CGa�✓q/�CT Yv Sr�,tiE�� �;iL'= <br />'i'il i/1�1. (�Fi.S 1,JFl �f� �-F�f1-I�r'i-.l. 1�V?�� r'� �L Ti l�S �w.L' IvGI� Lf}r �tl'. <br />5-��1- o <br />�y2o� <br />z/o . s`�3� <br />'l �(i -70 � l <br />CONTRACT PRICE OF WORK <br />Tj v, r/'l7O_ �U <br />� <br />NO. I TYPE OF FIXTURE OR ITEM <br />I Tailet <br />_ Bathtub <br />Lavatory (wash basin) <br />_ Shower <br />Kitchen sink & disposal <br />_ Dishwasher <br />Clothes washer <br />_ Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease irap <br />Roof drains <br />Oiher <br />NO. 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 <br />� Clothes dryer <br />Range hood <br />^- Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrige2tion <br />Woadstove <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correc!. All provisions of Iaws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The grantiny of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 2462D0 WAC. <br />li � Zc��� <br />Date I�� <br />