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� <br />za'�`°"� �S0.i2 PE�MIT APPLICATIOi� <br />CITY OF EVERETT PEP.MIT SER�lICES <br />3200 CEDAR STREET, [VERETT, Vo'.4 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettv�a.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEEiIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # �PERMITlt <br />�//Y �,�o-r�- `DR ���0�`�17c`inoc>oio CG5o3-o��`i� <br />LEGAL LOT NO. BLOCK TRACT � I�U�' —��f/"7 <br />�CSC. ' !"!5. /f'!tJ ' L/' i 1 /4�ILLv- C// <br />� �� . � r �L �s Y22 -ZO S / C <br />i E N,f)I S �,�'�rdni �S�/ Teck3` L'-ui ra/ `%�1t�7 :1 YJ- /�J2 . <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />j Y�"� I <br />CONTRACTOR <br />_, , } ��! (: <br />CONTR. LI�ENSE # <br />USE Or BUILDING <br />- �.�a,,,-I�� I ����p le� <br />A�DRESS <br />HEATSOURCE <br />_ Electri.: � Gas _ Olher <br />WORK DESCRIPTION N <br />/J�'w �uN��-1— A ��`1P`P%� �� <br />NO. I TYPE OF FIXTURE OR ITEM <br />4 <br />Tailet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitci�en sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbarlmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CITYIZIP PHONE <br />�f Cyr.=_2o6/ <br />C �'::nl l <br />. l ;.fl ��JL <br />L_ <br />�S 7 � <br />� <br />a�s <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />k' Forced air systems <br />� l Gas piping <br />I_�, Waterheater <br />� .x Gas fireplace <br />��, Gas range <br />1 � Clothes dryer <br />� �� Rang� hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinacas governing this type of �vork will be complied wilh whether specified herein or noL The granting of a permit does not presume <br />to give authonty to violate or cancel the provision of any other state or local law regulating construction or the performance o� <br />construction. That I am authonzed by the owner of this property to perform the work for �vhich application is made and I comply with the <br />State Contracrors Law 18.27 RCW and 296.200 WAC. <br />�a.�5 ��L <br />