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9 <br />---- -- -- --� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT. WA 98201 <br />425-257-8810 - FAX 425-257-8857 - vn�✓���.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM T04 PM I�'��a—lZ <br />SITE ADDRESS PARCEL TAX I.D.Ii PtK �° <br />� G��r,�lti � 7 3 s2dfl �o � Z�x--� `� �V� 2 -' <br />L[GAL LOTNO. BLOCK TRACiORSUBDIVISION: �� Jr�� �� <br />DfSC. 2 Y\/. � ` <br />OWNER � ADD� �J ���1�) � � TM�z PHONE <br />�.tos � 3'/ G �% � �( O C��t. � _ �i�o-t��IX`. r'l �2O j <br />TENANT NAME I CO ACT FORPERMIT PHONE (� Z S��� %- I�/ I'� <br />�rJtGt��i E-MAIL 1 �FOLNi/.f1/'/�'Uf4) �jf <br />CONTRA�(OR r�/� nLw.y/r�. )7u�i�.� c/ t ADDRE S�G/S' Ce/ CITYILIP NH�FiE t�Z � 3�f%.Iy/ <br />�• s ����, Y <br />.. �' n� #"l"-C� �v��' Gt,� <br />CONTR. UCENSE N L,�.2�C' <br />/Jrv/�/�/f'j f /3 G /) � <br />USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br />���� � /�� /' � D _ [lectric � Gas _ Other � � �� <br />r / <br />WORK DESCRIPTION ��L�C��,� � �"'rl L7J � <br />,O L p� <br />V <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />�athtub <br />L2vatory (wash basin) <br />Shower <br />Kitchen sink 8 disposai <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (serv�ce/badmop/elc.) <br />�ackflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Other _ <br />Np, I TYPE OF FIXTURE OR ITEM <br />NC — air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Ezhauslfan <br />lieat pump <br />Unit heater <br />�oiler <br />Refrigaration <br />Woodstove <br />CITY Of EVERETT LOCAL SALES TAX CODE IS J705 <br />I hereby certify that I have read and examined this applicahon and know the same to be true and correct All provisions ot laws and <br />ordinances goveming lhis type of work will be comphed wdh �ehelher speafied herein or not The granting of a permit does not presume <br />t� give auUiority to violate or cancel th� provision of any othzr sta(e or local la�.v regalaGng consUuchon or the performance of <br />��onstruchon That I am au�horized by �he owner of this property to peilorm Ihe work for which 2pplicaiwn is made and I comply vnth the <br />il�. Contractors Law 19 ?7 f �nd 296 20J WAC <br />� _.. /,�, %%� /Z�l �d �/Z <br />��� <br />m <br />Cv� <br />