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PERMIT APPLICA'TION <br />CITY OF EVERETT PERMIT S�ERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />; -, <br />i r.,_ !�� <br />; � , J�,` % � 7 <br />APPLICRTIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />� (1� <br />LEGAL LOT N0. <br />DESC. <br />�J�'�� �� �/1�:�� <br />� e�ocK <br />TRACT <br />PARCEL TAX I.D. # <br />�C�.a I ���C� L�OI ) C'U <br />�('AUT/1ST /'c;��'�r���J z�`//� J ��' ��Ic�� �i J�11�1{',d1+-,�°�ti'h-���r„- <br />TENANTNAME CONTACTFORPERMIT PHONE <br />CONTRACTOR �F%� 1rr �,L I� yJ%r;� r�', C M� AODRESS j�Sa �'S S�' Cy7,Yr�l P P}tONE ��l j ��{- � <br />� Kr.Aine.� lA/ fi <br />CONTR. LICENSE 1F /n v r� J� �^!' ,' / 1. .� C� m <br />!li 1 Cl <br />USE OF BUILDING HEAT SOURCE <br />l�,�/1 /n p ��,1 F{� ,� Elednc � Gas _ Other <br />WORK DESCRIP710N <br />��,��r,(I .r�✓ic �ti'aJ�Q q:,; i,�,.r'lF-� r�/ <br />NO. I T'/?EOFFI:(TUREORITEM <br />Toilet <br />BatMuh <br />::vatory (wash basin) <br />Shower <br />Ki•�chen sink & disposal <br />Dishwasher <br />Cl�thes washer <br />Laundry trey <br />Sink (servicelbar/mop/elc.) <br />Backilow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />3rease trap <br />Roof drains <br />Other <br />.� <br />CONTRACT PRICE OF WORK <br />y-�J bnc� <br />�r�c ��vy S���) <br />NO. I NPE OF FIX7URE 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 />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />I hereby centity that I have read and examined this application and know the same lo be true and arect All provisions of laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or nol. The granting of a pertnit does not presume <br />to give authority to�violate or cancel the provision of any other stale or lowl law regulating wnstruction or the pertormance of <br />constructicn. That L m autho �zed by the owner of±his property to pedorm the work for vrhich application is made and I comply with the <br />State Cootrectors L�w 18.27 CW and 296.200 WAC. <br />• 1�1�/LrI " C I ���I F-- <br />