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PERMIT APPLICATIOIV <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 PARCEL TAX I.D. # PERMIT # <br /><' c� S� �y�e ��c i MRu. '( 28✓5t8��3o�--,poo ,Q C� -(�C " <br />DESC. LOT NO. BLOCK TRACT f�y � 4t f 3 S S EI }� <br />OWNER �� �eb�.✓S�, Fua��'/ ADDRESS wl\ W CITYI�IP feAPF�E 2 A�r <br />ttt'ies Sa�+SCt3/��+M I� �'fy►A},E✓G • y,j'3^si`� <br />'�f�--�rXtE �� ! 4 �I+��e L-�5'i,t1�i � ��Arn r- G D� i a .z � �, �,_ <br />�"7'"'P^v—\�� 4�'sL�w <br />TENANT NAME � H C}-� I I.iG-� g71,�jF,�{� CONTACT FOR PERMIT PHONE �' 4z 5- 3 s s- eY o <br />-t�X 1��,� ��ru ;''`�� I EVA �TAM ��.ofol �-z�- ��5� <br />CONTRACTOR <br />CONTR. LICENSE # <br />ADDRESS CITY2IP PHONE <br />i� �� �0 41 ��►� �,�� S �� ao 6- �2�.- <br />Se�n�'�'�C � `� 10 $ $d�� <br />USE OF BUILDING <br />y�� St0.0 v vc�, � <br />!�s-� u{� ��rt <br />WORK DESCRIPTION <br />TE��T 1'�lf ��`/� ML �`1" <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Root drains <br />Other <br />HEATSOURCE <br />Electric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />5p, o00 <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 firepiace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify thal I have read and examined ihis application and know the same lo be hue and correct. All provisions of Iaws and <br />ordinaces governing lhis type of work will be complied with whelher specified herein or not. The granting of a permit does nol presume <br />lo give aulhority to violale or cancel lhe provision of any olher stale or local law regulaling construclion or the performance of <br />construction. That I am aulhor' ed by the owner of lhis properly lo perforrr the work for which application is made and I comply wilh lhe <br />Stale C� trac� s Law 1 CW and 296.200 WAC. <br />U�/ G Vl�l / <br />