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P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <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 <br />SITE ADDRESS <br />" ^ � �.�. � ,�(�-l�,ti�1, il t�! '>�,,�. ��t�1 �� <br />.LEGAL LOTNO. BLOCK TRACT <br />DESC. <br />OWNER ADDRE <br />` I �� <br />VI \ � �i 1 l .�l � C' �'' � _,.. o <br />CONTR. LICENSE p <br />-'�� h C� �. <br />USE OF BUILDING <br />�nnri � �� �' I-��� � S <br />WORK L <br />�``lG� G� <br />ESCRIPTION <br />(zi'�uC�.i l - p �t-1 <br />,� <br />�' � �irvt h�� �T � �� ��-� C�oO<S <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />Lavalory (wash basin) <br />Showe� <br />Kitchen sink 8 dis�osal <br />Dishwasher <br />Clolhes washer <br />Laundry lray <br />Sink (servicelbar/mop/elc.) <br />Backllow prevenler <br />Urinai <br />Drinking Fountain <br />Floor drain <br />Grease Ira;� <br />Roof drai,is <br />Olher <br />PARCEL TAX I.D. # <br />�f a�o.� v�av � a v� <br />COflTACT FOR PERMIT <br />�1 C.�1{� � � � ` �Q �l� <br />ADDRESS <br />HEATSOURCE <br />� Electric _ Gas _ Other <br />�� :u�i <br />ScfC/ �(b� ' `�t(o L I <br />PHONE <br />yz�-�s��_ c;�(�7 <br />CITY2IP PHONE <br />I CONTRACT PRICE OF WORK <br />t,��� � �c(���d� l,tjc,��S � C' �i��:. ���b"�i-i�� <br />rU� �1�t�.0 ��CY%'\5� �N\�.l\` P����,,P rtil,r.n���q <br />. <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C – air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify thal' have read and examined lhis applicalion and know the same to be true and cortect. All provisions of laws and <br />ordinaces governing liLs type o( work will be complied with whelher specified herein or noL The grenting of a pertnit does nol presume <br />to give aulhorily to vio�ate or cancel the provision ot any olher stale or local law reguiatlng construction or tho performance of <br />construction. Thal I am aulhorized by lhe owner of lhis property lo perform lhe work for which applicalion is made and I comply wilh lhe <br />State Contrar.lors Law 1827 RCW an�f 296.200 WAC. <br />V . � �v'A' <br />' � �FlGlc(�"��� - 1 /Z1/d� . <br />�Si�naWr of wnedContractodAulhorized Agent —ate <br />. '/z <br />