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PERMIT 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 I PARCEL TAX I.D. # <br />�`��S ��= C-v`-vs�„- Maw.JA�i , S� }- <br />LEGAL LOTNO. BLOCK TRqCT <br />�J�OCH 1�c-'G\t=QT�j 11.0 iOSCI %�) FkuJ `iT ��\ � �„uL <br />� <br />COMACT FOR PERMIT PHONE <br />�Cv�Dq�� Gz-�I5i5 ; <br />icnnn�name <br />5 �? 'e—\ tJ �' <br />CONTRqCTOR <br />"5�3� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />N�- kL-.�'4\� <br />MDRESS <br />�-J ��' CU�I��� <br />Q�7Y2IP PHONE <br />� ��� <br />HEATSOURCE <br />_,ElecUic �Gas_Other <br />Z�� 3 <br />CONTRACT PRICE OF WORK <br />�°S0,"OGG °O <br />WORK DESCRIPTION <br />�n)-�~c�ca T�,,AN� \r,nPe-Gvc�.+,�a ;���= tx�_, , <br />' -1�Jc�,S�r�c�. � <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash bas(n) <br />Shower <br />Kllchen sink $ disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease Vap <br />Roo(drains <br />Olher _ <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced s�ir systems <br />Gas piping <br />Water healer <br />Gas fireplacn <br />Gas range <br />Clothes dryer <br />Range hood <br />F�haust (an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />i <br />�% <br />I heraby ceritify that I have read ond examined this appiication and know the same to be We and correcL Ail provisions of laws and <br />orclinaces goveming this type of work will be camplied with whelher spedfied horein or not The granting of a permit does not presume <br />to give eulhority to violate or cancel Ihe provision of any other stato or local law reguiating consWction or the performance af <br />consWction. That I am authorized 6y the owner of this property to pertartn lhe work far which applica[ion is made and I comply wilh the <br />Slate Contractors L�ew'i82%R61C�and 296.200 WAC. <br />