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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 -- FAX 425-257-8857 - www.evercttwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />09 t, <br />PARCEL TAX I.D. # <br />RWT <br />���-' <br />1�o3-ct : I—Victfl-No)l, <br />I� ( J`i ✓ <br />LEG A LOT NO. <br />BLOCK <br />TRACT OR SUBDIVISION # <br />DESC.Cc <br />i <br />OWNER <br />ADDRESS <br />CITY/ZIP <br />PHONE <br />t'I/ese4` M1o1 of LLe* ►?'ill <br />VeN�uvi Pt_Un 5--i,.A,_,, <br />r—&,CA <br />gl6o` <br />r <br />TENANT NAME <br />CONTACT FOR PERMIT <br />PHONE <br />p 9) -7 13 - 00 30 <br />S`, J <br />CI11n�I-►�� - <br />( {'IFJ Iu <br />—" Park- <br />J i N+ .� <br />E-MAIL <br />^?r A-. f, <br />CONTRACTOR NWr <br />AUUHtt$ <br />CITYOP <br />PHONE <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />I CONTRACT PRICE JF WORK <br />I <br />Electric _,Gas___Other <br />��% Lal) #^A'4) <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ Toilet <br />_ Bathtub <br />_ Lavatory (wash basin) <br />_ Shower <br />_ Kitchen sink & disposal <br />_ Dishwasher <br />_ Clothes washer <br />_ Water heater <br />_ Sink (service/bar/mop/etc.) <br />_ Backflow preventer <br />_ Urinal <br />_ Drinking Fountain <br />_ Floor drain <br />_ Grease trap <br />_ Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ A/C — air handling units <br />_ Forced air systems <br />_ Gas piping <br />_ Water heater <br />_ Gas fireplace <br />_ Gas range <br />_Clothes dryer <br />_ Range hood <br />_ Exhaust fan <br />_ Heal pump <br />_ Unit heater <br />Boiler <br />_ Refrigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES 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 />ordinates go ruing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authori to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />-onstruclion. Tha I am authorized byofhe owner of this property to perform the work for which application is made and I comply with the <br />,tale Contractors w 18.27 nd 296.200 WAC. <br />l y1oz/. <br />thorized Agent uate 71 If <br />n, (3.e,^ a <br />