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PERMIT APPLICATI <br />CITY OF EVERETT PERMIT SFRVICES <br />3200 CEDAR STREtT, EVERETi', WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT <br />SE E'J�C-'�2E-5T mmMl i„� ' b7- D/ �_ <br />DEoA `OT NO. —�OCK TRACT . <br />OWNER ADDRESS CITYIZIP PHONE <br />S,E��rnE �ri"�sd1- ��.L <br />I�131�-1 S�„� A+��„v nwD �,�.�es�t-t,,,� S�3 •G2(o• �`t�Y <br />TENA'NT NAME I CONTACT FOR PERMIT PHONE <br />�r�5r�- �resN i�a�..1 .''�'s�6�1� �(zS-z6o-b�1Ss <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />PE(zFCC � C�I M A� 1 N L �( �-l'i-� 22l Si � �. fl.r (�E1? �f�S� �2% 26v - 6'� S <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEATSOURCE <br />i <br />Electric �_as _ Other <br />WORK DESCRIPTION <br />1 NSTl�\) OWrvtr SwQQL l-.� GI.ASS � (�z7c�D� I NSi�R« <br />17�c�wonc� �NSM�� muc.Twr�r�c fvr 2�. E�1��n.G. <br />1 n�s i w<< rnu,a � Dvc.Z- ►�1-E�v ;t1Z . <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />� Lavalory (wash basin) <br />Showe' <br />Kitchen sink & disposai <br />� Di;,nwasher <br />Cbthes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />� Backflow preventer <br />Urinal <br />_ Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />� Other <br />CONTRACT PRICE OF WORK <br />2 �jU . C_a) <br />3 �H �s � <br />('cwi�-u � M1-/c. un,.'t'S, <br />NO. I TYPE OF PIXTURE OR ITEM <br />A�C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Cbthes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITi �F EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby ceritify lhat I have read and examined this application and 4now lhe same to be true and correct. All provisions of Iaws and <br />ordinaces governing lhis lype of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />lo give au:horiry to viulate or cancel the provision of any other slate or local law reguiating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform lhe work for which application is made and I comply with lhe <br />State-2e�lracrors L 18.27 RCW and 296.200 WAC. <br />�� � p G <br />5 nature of Own . �untractodAuthonzed Agant Date �/� <br />