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pERMIT APPLICATIU�V <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 �-- a6 -o� <br />SITE AUDRESS7 <br />j� 2'Z C c'�: -l/�i�2 cJ �!% • <br />LEGAL LOTNO. BLOCK <br />DESC. <br />OWNER <br />��? ��'-� �i�Z2 <br />TENANT NAME <br />IIKAI.IVK <br />r--� /z,,1�:.-� K S G �.,� �� <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION k <br />L u n�+ �S .���i .�v L� <br />CUIJTACT FOR PERMIT <br />�L'��� (�CL�. J I�-� <br />CONTR. LICENSE # <br />�3<«�ec�-�c ia-iJ� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />� -L� � i� o � �� i.ic� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />I<i(chen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/barhnop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />'' ' Zvl-� 30�• is� � <br />i <br />PHONE�pb� 300 � / S � � <br />E-MAIL U'�cpks � �'i.k..�l�n <br />S2i5 N� �l crL�-2�>,,,..z,� •a�3=��zz2-o�S <br />�jd'OS / <br />HEAT SOURCE I CONTRACT PRICE OF WORK <br />_ Electric _ Gas _ Other I � 'Z �� <br />MtGHANlGAL <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />f-orced air syslems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined lhis application and know the same to be lrue and correcl. Ail provisions of laws and <br />ordinaces governing lhis lype of work will be complied wilh wnether specified herein or not The granting of a permit does not presume <br />lo yive authorily tc ✓iolate or cancel the provision of any other state or loc:�l law regulaLng conslruction or lhe performance of <br />consiruction. That I am authorized by the owner of this property to perforrn the work tor which application is made and I comply with lhe <br />Slale Cpntraclors Law 18.27 and 296.200 WAC. <br />.� �"�_� . r �-• 2 L- ��,r <br />