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PEkMIT APP�.ICATIOh <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 />APPLICATIONS ARE ACCEPTFp FROM 8 AM TO 4 PM �� .r/ �' —O� <br />SITE ADORESS <br />l 2.3z b a,,.� u� N L. .': <br />LEGAI LOT NO. 9LOCK <br />DESC. _� � i' <br />OWNER <br />1��=' `sz���:� �'nazTl�_F.s �.L�� <br />TENANTNAME <br />CONTRACTOR <br />2PARCEL TAX I.D. # PERMIT # ^� <br />2�0511 -1c�21 � n�� � �:�"G-� <br />TRACT <br />ADDRESS CITYRIP PHONE `y� <br />121q5 �/iU�Ctcs Nv�C.� �i�0 WA• �`18-p8�� <br />� ��..-r,so QL �# �n� �'io-�'�-iG <br />, I CONTACTFORPERMIT PHONE <br />�j r' � Q /''�p�/� <br />C� ,��i � ��1�{�� ��`ZCJI��U�'`J�_.1�J� <br />ADDRESS CITY2IP PHONE <br />CONTR. LICENSE #; ' � ��, : � ��� <br />USE OF BUILUING <br />�2.�?S� O�� \ 1 A.,L. <br />�.F. <br />WORK DESCRIPTION <br />�_,r..�r.�Q.; �r1 c�� � ' � <br />c�{ P� (LA C-c t= � '. <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />_ Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwashcr <br />Clolhes washer <br />Laundry tray <br />Sink (service/bar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />' . ' : � ', !.,. •' •', <br />� <br />HEATSOURCE <br />_ Eleclric _ Gas _ Other <br />� <br />CONTRACT PRICE OF WORK <br />Z 7 ��.� <br />i <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Porced air systems <br />Gas piping <br />Water heater <br />Gas (ireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify thal I have read and examined lhis application and know the same to be true and correcl. All provisions of laws and <br />ordinaces govemin� lhis type of work H•ill be complied with whether specified herein or noL The granting of a permil does nol presume <br />to c�ive authority to violate or cancel tho provision of any other state or Iocal law regulating construction or the performance of <br />construction. Tbat,t- au�orized by the owner of lhis property to pedorm the work for which app�ication is made and 1 comply wilh lhe <br />State Conlractors L'a�18 27 RCW and 296200 WAC. , , <br />ty <br />