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PERMIT APPLICATION <br />CITY OF EVERETT PEFiMIT SERVICES <br />3200 CEDAR STREET, EVERE'T7, 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 ADDR SS / <br />� 903 om �a�d �v2 <br />LOT NO. <br />K�Vin �(ot�ensDl� <br />BLOCK <br />�''943 <br />PARCEL TAX I.D. # <br />-Z <br />TRACT OR SUBDIVISION # <br />o�-n �aro� /%ve _ �v�re ,�� t.yA 9cf 20,3 <br />TENANT NkME ` I CONTACT FOR PERMIT PHONE <br />E•MAIL <br />ACTOR ADg� STS- li IZIP HO <br />'�m�Javd So�u�:air, Ine /3y�6 /ac.{�c Po;n� �. /Yra,E,�«ra wv� 9c�i.jS <br />CONTR.LICENSE#�O�r�SI9OSOZ 92Z �� �1�• 3�3.��5Y�-- <br />T <br />USE OF �UI�DING <br />HEATSOURCE <br />i <br />Electric _ Gas V Other � <br />CONTRACT PRICE OF WORK <br />� �00� <br />WORK DESCRIPTION qp wa �tr �lofer /trG��� <br />�aHrcr/a:.,y �in 9i'e �ui�+wit a�o9Us� �9 i <br />/rCG�.� GL�G�J i�/ 6ocw+�an� �l'¢w�4.s -lr'�'. <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />� <br />� <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Sliower <br />Kitchen sink & disposal <br />Dishwasher <br />Glolhes washer <br />Water heater <br />Sink (service/barlmop/etc.1 <br />Backilow preventer <br />Urinal <br />Drinking Foun�ain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Olher <br />NO. I TYPF OF FIXTURE OR I�tEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigcration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify ihat I have read and exartined Ihis application and know the same to be irue and wrrect. All provisions oF Iaws and <br />ordinances goveming this type ot work will be complied wdh whether specified hereiu or not. The granting o( a permi'; does nol presume <br />to give authority to violate or cancel Ihe provision of any other stale or local la�.v regulating wnstruction or the peAorrnance of <br />conslruction.� at I am authorized by iha owner o`ihis property lo periorm the work for which application is macle and I comply wilh the <br />State ^ontr,eElors :.aw 18.27 RCW and 296.200 WAC. <br />i2-o.� -/O <br />-� <br />