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P�RM�T APPLICATION <br />CITY OF EVERET'r PERMIT S�RVICE� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CR[DIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # i? <br />,,��;� ��� ��:��.r.-��� ,�-�„� ����, I ; �-r��� - .� <br />LOTNO, i BLOCK I TRACT <br />DESC. <br />....�.�� ,.......�.... _. ._. .+ . _._ <br />Nc� .�r='.-. <br />'7iLG� I�`•'7� ,-�.�, ,, t--�7�=7 :�-`=i�( `7uv` ���f�Cl��`�-. f �.��i� �� ��i�l�%-,'��–LL7Li: ' <br />TEN NT NAME CONTACT FOR PERMIT PHONE <br />%'4� 1 GLf_ Iti� �� iL�i �- •�+v��v" �jr«� �l`���-' " c�al � <br />CONTRACTOR %�� ,ry`-rf�.j–� C(�'C'77'� �- ADDRESS ��'i) fll.C� S. �ITYIZIP PHONE � <br />C��_�� <br />. � �; �-�r -� �_ : - <br />CONTR.LICENSE# -- � r_L�t-,i;/ -y�.:j fr--i ll �,–G'»i <br />�It.i�. i �_ L. ''�i`'-:`'> 1sC.1 , J �_%'�J�� � � � � <br />USE OF BUILDING HcAT SOURCE I CONTRACT PRICE OF WORK <br />� � <br />� ��r j �'t � � _ Electric _ Gas _Olher '�? f [`�� � �� �_t:'. ! /`j� � <br />WORK DESCRIPTION <br />� ���r;��.t �� <br />/i�'1[�-r�, Y" <br />PLU <br />� r,� �r�L C �_ � ����� v�:'.� �i_ � � � ���' �Tlc'�'( ��r 1 � <br />, �� <br />, ll � n�:. , � c ,'� <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />BaPi�ub <br />La�atory (wash basin) <br />� Shower <br />Kilrhen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />_ Laundry iray <br />Sink (service/badmop/elc.) <br />BackOow preventer <br />Uri�al <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HANIGAL <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 freplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify thal I have read 2nd examined this application and know lhe same to be lrue and correcl. All provisions of laws and <br />ordinaces goveminy this type of work will be complied witii whether specified herein or not. The granting of a permit does nol presume <br />to give authority lo violate or cancel Ihe provision of any olher stete or local law regulaling conslruclion or Ihe performance of <br />�onstruction. Thal I am aulhorized by lhe owner of this property to perform the work for which application is rnade and I comply wilh lhe <br />State Contractors Law 1827 RCW and 296.200 WAC. <br />ISignaWre of OwnedContraclodAulhorized Agent Date <br />i <br />�.--- -- --- -- -- � — -- <br />