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PERMIT APPLICATIAN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9820 � <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.o�y <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -1- � p'1� _GC�j ! <br />F <br />SITE ADUi?ESS I PARCEL TAX I.D. # PERMR #/� / <br />� i�-� :'� F=� ,.—n.�,-r �M i �_�I A%S�ii�� 14hn 2i�C/!�/'v') I ��C��y '� <br />LtGAI.� LOT NO. I <br />DES0.� <br />OWNER <br />`�l'Fil �, j$n�.l � vP> tzrl }S � <br />TENAty�! NAIy�E <br />�% (VlJ'1 v <br />�FivE� i � �I (�i.i C(� • <br />CON7A. CENSE# <br />USE OF BUILDING <br />trN��• 5�ru� e ,1,� <br />WORK DESCRIPTION <br />�ln-I�.I <br />�� - F�t c� S 1 ��.I � <br />BLOCK �7RACTORSUB6IVISIONlt <br />ADORESS C� <br />1c ��E 5�o s� �vE►u�r M�� <br />CONTACT POR PERMIT <br />f'�D�E$SIT�iIw'IVN � <br />I�U �S� �iq% /-�BEi2� <br />I — HEATSOURCE <br />Electric _ Gas _ Other <br />IIJ��ld:A_ l9 ) I /7/.1�� fl' �� <br />NO. I TYPE OF FlXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 dispasal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Roof drains <br />Other <br />E-MAIL <br />�(�SZ4 <br />z-II�I <br />3Gv�5�Z-!nl <br />CONTRACT PRICE OF WORK <br />� 7� Sbl�• � � <br />TYPE OF FlXiURE OR ITEM <br />AIC — air hand�ing units <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 />Refriyeration <br />Woodstave <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granling of a permit does nol presume <br />to give authority to violate or cancei lhe provision of any other state or local law regulaGng constructlon or the performance of <br />construction. That I am aulhorized by the owner of this �.roperty to peAorm the work for which application is made and I comply with the <br />Stale Con�ractors law 1827 RCW and 296.200 WAC. <br />� 7 , i.,,�` � � %Z -U'7 <br />