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PERMIT APPLICATION <br />CITY nF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, cVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — v+ww.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� <br />SITE ADDRESS/ � ��' PARCEL TAX I.D. # <br />�/riZ 7� f v�7l��JJLC, vl%q 2�'U� uP+U:>i � OG <br />LOT N0. <br />"_'�%��y�r-p`�T <br />BLOCK TRACT OR SUBDIVISION # <br />��7I" -'L1'� LC. <br />TENANT NAME CONTACT FOR PERMIT � PHONE <br />,��r���-�c�� �,�� ��.,�; «;yc�� <br />E-MAIL <br />�,3�rG /�:r����k:�FL 'a'�'S Z�� 5�� st �02 <br />CONTR. LICENSE B � .,_ � (y / ',,� . ,-_ , , ; <br />�L� E;_ /i-7i� s?`.', i� c i % <br />USE OF SUILDING <br />;1�� //,� /L. <br />6VORK DESCRIPTION <br />N0. I TVPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />� Lavatory (wash basin) <br />Shower <br />� Kitchen sink & disposal <br />/ Dishwasher <br />_� CIOIheS wa5her <br />� Water heater <br />Sink (serviceibadmopletc.) <br />Backflow preventer <br />Urinal <br />Drinkicg Fountain <br />_ •� Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEAT SCWRCE <br />_ Electric _ Gas __ Other <br />�➢ERMIT # <br />i /C�- � <br />z �r <br />4� <br />" /�2 /i �; <br />PRICE OF WORK <br />�� c�".%L`� <br />N0. I TYPE OF FIxTURE OH �TEM <br />_ ,�/C—airhardlingunits <br />rorced air syslems <br />Gas piping <br />W ater heater <br />Gas fireplace <br />Gas range <br />Cluthes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Relrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />i hereby ceritily that I have read antl examined this application and know ihe same lo be true and correcL All pmvisions of laws and <br />ordiraces governing this type of work. will be complied with whether specified herein or not The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the pertormance of <br />construction. That I am authorized by the owner of this property to perform the work fnr which application is made and I comply with the <br />State�qntracrors Law 1827 RCW nd 296200 WAC- <br />l�� /�i� L� ��•C�„'/'%� / �'2 �C��% <br />