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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVlCES <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 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />So2 sE �vr1'�lrrY1A�.�wAy � f� I ?�j Gsl�j-oo;� - o�o.. o o ��Ca —� <br />LEGAL LOTNO. BLOCK TRACT <br />DESC. 56E '"j-�,6 <br />OWNER ADDRESS CITY/ZIP FHONE <br />�✓C-�' �Lc-�� �A2BE/�. � g�Au`l'�j Cc�L1�GE -SAMEAS AeicvC. 4zs.4z3 -�f�6 <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />EVE�-G�G-�/v B�B coG�E-C�E C-�''ua6 N� <izr.��o_E�o6 <br />CONTRACTOR'nA�/1S ����zE1�- ADDRESS CITY2IP PHONE <br />CONTR.LICENSE# 2`�m`�������zOp W�p,�98�� Kz'.���5.��{c�o <br />� � vx�'I - f �S�N _ <br />USE OF BUILDING � HEAT SOURCE � CONTRACT PRICE OF WOFK <br />�f4�BG-/L �� {3GAv l�J CO�a�- I _ Eleclnc �as _ Other I� 15o��oe� <br />WORK DESCRIPTION <br />•z�663 sF TE,�P�`'� ZM P,QoI/E,�c� (�' �1D D M�z�NrNc 7'o TN� ��C%sT ��c�, <br />GI'p�� �"�� �'�� �'�G NC�� ,,�l��ows :�n.� 7�e�T62�o2 v�1 �L-�. <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />BackFlow preventer <br />Urinal <br />Orinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas renge <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeraiion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating canstruction or the perfortnance of <br />construction. That I am authorized by the owner of this property lo perform the work forwhich application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />1�� 0'`/�G� c��� ( I O S <br />/�j jG�- 0 <br />