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t-tRMIT APPLICATIt�N <br />Ci i Y t3� �V��'�TT PER�!l6;T S�::L-':��� <br />;t2pp C[pqR. STREET. FVERFTT, WA qR�(11 <br />4L'J-L'Jf�001V-fH/�YLJ'LJf'OOJ� -\YW\'C.GVCICIIWC.O1tJ <br />APPLICATIOhS ARE ACCEPTED FROM 8 AM TO 4 PM ^��_ <br />SITE ADDRESS PARCEL TAX I.D. # Uv� �� �PERMIT # <br />�z3/s f�.�-.��z. ��.z� �z�3 � �a��� - <br />LEGAL LOTNO. BLOCK TRACT <br />��s^, of- F1�vin.n...� /%-+-� <br />OWNER ADORESS CITY2IP PHONE <br />C�c�rc.-c ���s,�,��. 18(�6 S• Lm� S�.n,�,�?� <br />, w � rc� <br />TENANTNkME <br />CONTRACTOR ��(il}G`{ I{p.�tr�Nw . A�DRESS <br />CUNTR. LICENSE R�� �,6zlJ � <br />USE QF 9UILDlNG <br />WORK DESCRIPTION <br />NO. I TYPE OF �iXTURE OR ITEM <br />Tcile: <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Disliwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmopletc.) <br />Backflo�v preventer <br />Urinal <br />_ Drinking Fountain <br />Floor drain <br />! Grease trap <br />Roof drains <br />Other <br />FORPERMIT '�� PHONE <br />r,o ��zc..n-�n ��Zs�3�y G�� <br />CITY/ZIP PHONE <br />��� <br />HEATSOLRrE <br />Eiectric Gas Other <br />COMTRP,CT ?P.lCE QF R4QP.K. <br />NO. f TYPE OF FIXTURE OR ITEM <br />A�C — air hand!in9 uri!s <br />Forced air systems <br />Gas pipinc <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />_ Boiler <br />_ Refrigeration <br />_ Woodstove � �y �� <br />Other � <br />CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br />iI hereby ceritiry that I have read and examined lhis application and know the same to be true and correct. All provisions of laws and <br />orAinaces governing this type of wo!!: �ti411 be ccmplied ��ith whether specified herein or not The granting of a permit does not presume <br />c oive authority to violate or cancel the provision of any other state or local law regulating construction or the perfortnance of <br />� ronstruction Th2t I am authorized by the owner of this preperty to perfortn the work for which aeptication is made and 1 coi�ip��� with th= <br />I State Cenhactors Law 18.27 RC\N an�6.7!y�,\NP�� , i <br />I 4/06 <br />