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PE�MIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />� l -OS <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � d <br />SITE ADDRESS PARCEL TAX I.D. # PER T# //� <br />,�j27 i�� �x' �1A( I b6Y�1S� 8�0 �Yso �� `�J <br />LOT NO. � BLOCK � TRACT <br />OWNER � ADDRESS GITYrzIP rnunt [��r <br />Jo N�,(� �c�� ,?j�27 tcG�i=P�L e�t�2 Ev�•c� �.o��� '!s`t,-s�' <br />TENANTNAME CONTACTFORPERMIT PHONE <br />s�r � s.� <br />CONTRACTOR i���, F� �,�� ADDRESS CITY2IP PHONE �` S <br />CONTR. UCENSE # T�t �:�v-�, b ll C2 S 3��L� Y'�a�L �W 'r` 'a✓'�""�' � l01 1 S 2-�'ro e <br />USE OF BUILDING <br />WORKDESCRIPTION i1� A�A <br />�5 r <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backtlow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />HEAT50URCE <br />_ ElecUic _ Gas _ Other <br />� �a��C�'-/ �%' /10o r <br />i da/�i <br />CONTRACT PRICE OF WORK <br />n <br />y� - <br />NO. I TYPE OF FIXTURE GR ITEM <br />AIC — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify lhat I have read and examined this applicalion and know lhe same to be true and cortect. All provisions of laws and <br />ordinaces governing this type of work will be compiied with whether specified herein or not. The granling of a permit does not presume <br />lo give authority lo violale or cancel the provision of any olher slate or local law regulating construcUon or the perfortnance of <br />construction. That I am authorized by the owner of this propeRy to perform the work tor which applicatlon is made and I comply with lhe <br />State Contractors Law 7 RCW and 29620� WAC. <br />e w�trac�onzed Agent ��� I�1 v <br />