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i <br />PERiNIT APPLICATION <br />CITY OF EVERETT P�RMIT 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 <br />j 4 f.� 4;,,�ll ('�C(. Ev�re.-I�t-i �,J�, <br />LEGAL LOT NO. �^ BL6CK J�1 <br />DESC. d � I <br />OWNER <br />�c.b!'t �l4V�Z. ✓I <br />PARCELTAXI.D.# Pf�2M��� � <br />nn�4s8aioorzov � <br />TRACT OR SUBDIVISION # I' <br />L�V i�r�- TI� ��h f{' I.( <br />�OWEt-L I�D, EV��ET i <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />E-MAIL <br />CONTRAbTOR �I ��,� AD�RESS CI IZIP PHONE <br />�f <br />CONTR. LICENSE # <br />USE OF BUILDING <br />iZ <br />HEAT SOURCE <br />Gleclric v Gas _ Olher <br />II <br />CONTRACT PRICE OF WORK <br />��3-�p - <br />WORKDESCRIPTION ���� i,,,�s a�{�{�, .���,�-j- �yd�c.l,� �c/c't�, � �{��v�F,r- <br />-�'o tX'� �':L'�"�rUov�n, <br />NO. I TYPE OF FIXTURE OR ITEM <br />�Toilel <br />Bathtub <br />Lavatory (wash basin) <br />_ Shower <br />Kitchen sink & disposal <br />Dishwaslier <br />Clolhes washer <br />Water healer <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />NO. <br />TYPE OF FIXTURE ON ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />G�srange <br />Clolhes dryer <br />Range hood <br />Exhaust far <br />Heal pump <br />Unit heater <br />Boiier <br />Re(rig�relion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y lhal I have read and examined lhis application and know the same to be true and correct. All provisions of laws and <br />ordinaces 9overninc� this lype of work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />ro give authority to violale or cancel the provision of any other state or local law regulating conslruction or the performance of <br />consVuction. That I am authorized by lhe owner o( lhis property to perform lhe work for which applicalion is made and I comply with the <br />Slale Contractors Law 1827 RCW and 296.200 WAC, <br />i� <br />