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P�kMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — vwvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />D 3 J'C P-r�c i n S� <br />LEGAL LOT NO. BLOCK <br />DESC. <br />OWNER <br />�-IPkCi:�n�P�� V�S �OO�AC,4'� <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />PERMIT # <br />TENANT NAME � I CONTACT FOR PERMIT PHONE � <br />E-MAIL <br />NTRACiOR ADDRESS I 21P <br />c� W Yl 2� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />G[�� <br />0 <br />�R'1� <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Waler heater <br />Sink (service/bar/mop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />HEATSOURCE <br />Electric Gas Other <br />O �,�, t' <br />NO. I <br />330 <br />CONTRACT PRICE OF WORK <br />TYPE OF FUCTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT L�.;:AL SALES TAX CODE IS 3105 <br />I hereby ceritify lhat I have read and examined lhis application and know the same to be true and correcl. All provisions of laws and <br />ordinaces governinc� this type o( work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />to give authorily to violale or cancel the provision of any other state or Iocal law regulaling construction or the performance of <br />construction. That I am aulhorized by the owner of this property to perform the work tor which application is made and I comply with the <br />State Co'tra tors L 1827 RCW and 296.200 WAC. l <br />,-%���,,�.� �7/ In %n � <br />