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PERMIT APPLICATION <br />CITY OF �VERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wv✓w.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />���0 L � �,�cli �nn��\ <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />�y�� ��Kns� <br />TENANT NAM <br />��_ ����,i � <br />CO ACTU <br />CONTR. LICENSE # <br />C-1S p'`.P�+-5 � 3 roa <br />USE OF BUILDING <br />'ct� I PARCEL TAX I.D. # <br />WORK�ESCRIPTION uvtNu+-( OWI� <br />Pn�_:. .q.,.� ���4 �lc�rc S�u.�. <br />NO. <br />NG <br />TYPE OF FIXTURE OR ITEM <br />Toilei <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Waler heater <br />Sink (service/bar/mop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains n � � <br />TRACT OR SUBDIVISION # <br />i� L C�uerC�-i <br />CONTACT FOR PERMIT <br />PERMIT # <br />� <br />� -� _ �,C <br />PHONE <br />��erc H <br />PHONE <br />E•MAII <br />PHONE J?(� (,.�.Y� <br />S5� - 218 1�i�2 6'�-1 Vx�iui�F :vl-l'.S \.�r� <br />HEATSOURCE <br />_ Eleclric __ Gas 0� Other <br />CONTRACT PRICE OF WORK <br />5�nalt C�'�Y ylnp� 5�•:� t Oi1� <br />NO. I TYPE OF FIXTURE OR IT[M <br />A/C - air handling unils <br />Forced air syslems <br />Gas piping <br />W ater healer <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unil heater <br />Boiler <br />Re(rigeralion <br />Woodstove <br />Other <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y thal I have read and examined this applicalion and know the same to be true and correcl All provisions r; laws and <br />ordinaces govemina this rype of work will be complied with whelher specifed herein or noL The granting of a permit does not presume <br />lo give authority lo violate or cancel the provision of any other state or local law regulating construction or the periormance of <br />construclion. Thal I am aulhorized by the owner o( this property to perform lhe work for �vhich application is made and I comply with the <br />Slata Contraclors Law 18.27 RCW and 296200 WAC. <br />