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J <br />P�RMIT APPLI�,�,�ION <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 <br />SITE ADDRESS <br />. ` � � � ..._ 4 RY . Gd � <br />LEGAL LOT NO. f3LOCK TRACT <br />DESQ ;',.V,,,, <br />OW NER ADDRE <br />i <br />I vL�.?/ yA.�iw'[_.. i0. /j�f1,0/ G/Ii7. <br />PARCEL TAX I.D. # <br />_ �� c <br />plv 1�7-33 <br />3Go-G5i-�3.� <br />TENANTNAME CONTACTFORPERMIT (`��� PHONE ,a� <br />�"� �'J�00� ^%O��V'�JS <br />JOC%/��?�cs-� �Ga-69/-7.�tS 7 <br />CONTRACTOR ADDRESS CITY2IP PHONE, <br />P��Ci�r�'U %,6//i/�' S' �'�d /3X �.U/ �j,�C�' 4.Ui�C �M�� �Ga-69i_75'S7 <br />CONTR. LICENSE # L.II'Q 9fJ'Z.S.Z <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchzn sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/elc.; <br />Back(low preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Root drains <br />Other <br />� <br />HEAT SOURCE <br />_ Eleclric _ Gas _ Other <br />r�/�S' <br />CONTRACT PRICE OF WORK <br />NU. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />_L Forced air systems <br />=9� Gas piping <br />� Walerheater <br />_L Gas fireplace <br />Gas range <br />� Clalhes dryer <br />� Range hood <br />� Exhaustfan <br />_ Heat pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify lhat I hava read and examined lhis applicalion and know the same to be lrue and correcL All provisions cf 12ws and <br />ordinaces c�overning lhis type of work will be complied with whether specified herein or not. The c�ranting of a permit does not presume <br />lo give authonly to violate or cancel the provision of any othar slale or local law regulating construction or the performance of <br />construclion. That I am authorize� by the owner oF this propzrty lo peAorm the work for which applicalion is made and I comply wilh Ihe <br />Stale CQnlrectors Lavr 16 7 RC �V and 296.200 WAC. <br />/ � � L�� '% -� �'_� � <br />r'� /, � `�`' <br />Si alure of OwnedConlractor/Authcrized Agent Date J <br />. .._ �� ��<- <br />