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PERMIT APPLICATI�JN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 /, `,���6 <br />425-257-8810 – FAX 425-257-8857 – w�w�.everetiwa.org `(� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />ADURESS �� I�)' '�" 6 r=Gf �C t'''� PARCEL TAX I.D. # PERMIT # <br />:i il�"�k'.J��L;.,�...,,., 1.t1(� i_S'i/lGi>/)i):;,;v �✓i:) � ���1���� � <br />DESC. . J�, <br />OWNER <br />� - :I r' <br />TENANTNAME <br />�i,1.� , <br />BLOCK I TRACT <br />nuuneaa ��� <br />.���. � �,'�',�r'"r'2.'7 lC�i.r� '�;�,'�'rl !�'�( <br />!- ii_�i/; I __ �/?� <br />CONTACT FOR PER �T <br />�J" �3 � ��.L C'/� U f� <br />PHONE <br />?JM �Q ; <br />- 4u 4�B 1�5"� <br />9 Z..s. 9 3t`� <br />l4' 1,7� <br />��32b GG�11 <br />CONTRACTOR " w�� /�K� ADDRESS ���,3 ��;�{/) f CITYIZIP PHONE <br />� �-a� �� c h : lZ���-r �` c ��, s �� � � <br />coNrR.ucense� %U /3i FY✓I�iC�,`C'� �:' ��' <br />USE O� BUILDING (•j �(�(�q ��.L; <br />�����cc ��,� � 3�� <br />C/Lii/-� `l�>i/�'3'iL� �l'�LG' <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />WORKDESCRIPTION l�.rli�l� I��j��"nti-�'�Ir�lt .' /7f"'.1['/.11["1 /�iY��c, <br />Ni...� �J��,�hSn�,� <<<,''lI� Alt(L,' Alc�_? �.�iK <br />Np, I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 dispo,al <br />Dishwasher <br />Clothes washer <br />_ Laundry trey <br />Sink (service/barlmop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />C[�71 <br />CONTRACT PRICE OF WORK <br />J �.3G� l' <br />hi�"il Cci�ti[j <br />TYPE OF FIXTURE OR ITEM <br />AIC — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhas dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CO�E IS �105 <br />I hereby cerilify that I have read and examined tl�is application and know lhe same to 6e true and correct. All provisions ot laws and <br />orclinaces governing this type of work H�II 6e complied with whelher specified herein or not. The granting o( a pertnit does not presume <br />ro give authonty to violale or cancel the provision of any other state or local law regulating construdion or the pedortnance of <br />construdion. Thal I am aulhorized by lhe awner of this property lo periortn lhe work for which applica6on is made and I comply wilh the <br />State Contractors Law 18.27 RCW and 296.20D WAC. <br />' '~' �•L4 u/- <br />;;';� r�� �,.:/�; i��'���r-/�=� /;'--;,t_�_ " � <br />Signature of�ner/Contractor�onzed Agen� �ate � Z <br />