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P�RMIT A�PPLICATIGnI <br />CITY OF EVERET'T PERMiT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 88201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />1'ZZ �p ' l7� �N � d�+v �. Ah1� <br />LEGAL LOT N0. BLOCK <br />oesc. t� . � <br />OWNER <br />►�'w' gTa.��. �PrzzN�.s, �Lc• <br />PARCEL TAX I.D. <br />TRACT <br />213100 <br />I(-al --a 5 <br />IRESS CITY2IP PHONE y� <br />t2�a5 �/i�C�c� NVkt l�0 W4• �4,a•�Ea� <br />c_ �-�.rr� PL. �t ?n2 `�P��'tK <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />�� � r:' ` �--ll��-� �'CZCij j 7�p' L,JC:JL )�, <br />CONTRACTOR ' i � AD�RESS CITY2IP PHONE <br />_I l�" . �, � ; - <br />CONTR.LICENSE# �_.•' .. i. . ...� .,. � -�_,. , . . • n, � • . � ;: , <br />USE OF BUILDING <br />�2�`a�17l..i"'�\�A.,L. `.�.F. <br />WORK DESCRIPTION <br />�,�����: ci v� � � <br />�i P CLA C� �. � �,. <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toiiel <br />Balhlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes �vasher <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />BackRow proventer <br />Urinal <br />Orinking Fountain <br />Floor drain <br />Grease lrap <br />Roo( drains <br />Other <br />HEATSOURCE <br />_ Electric _ Gas _ Olher <br />� <br />CONTRACT PRICE OF WORK <br />� �.^'1 �^�7 <br />MtGHANIGAL <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handiing unils <br />Forced air systems <br />Gac piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Ranc�e hood <br />Exhaust fa� <br />Heat pump <br />Unil healer <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify �hal I have read and examined this applicalion and know the same lo be lrue and correct. All provisions o( laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or not. The granting of a permit does nol presume <br />lo give aulhority to violale or cancel lhe provision of any other stale or local law rec�ulaling construction or the per(ormanco o( <br />construclion.SliaLl am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Slale Contractors L 18.27 RC and 296.200 WAC. <br />� �1 � ___._ `1�i`1 Ic�� <br />`�z <br />