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PtRMIT APPLIC/�TIUN <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 />�O z �t/f ac�'i0„ <br />LOT NO. � BIOCK <br />DE50.J <br />OWNER <br />P�/ ����L�s�,� <br />TENANT NAIdE <br />�ti�r <br />TRACT <br />%2v% /7�>. <br />CONTRACTOR �/ /� /. / //'� L, % <br />�i7) Q ((�Y7 1'GV 1 <br />CONTR. LICENSE # <br />USE OF BUILDING <br />FARCEL TAX I.D. # <br />CONTACT FOR PEP.MIT <br />ADDRESS <br />HEATSOURCE <br />�C Electr'c _ Gas _ Other <br />al .-I � -O.b <br />PERMIT # <br />in,.,na,_.n�1L� <br />/vf�r�' � w� � `�7 <br />PHONE <br />CITY2IP PHONE <br />CQNTRACT PRiCE OF WORK <br />�/D,C4o <br />WORK DESCRIPTIOY y� p <br />//P�kO/��.�r C'c. ¢� 5'�J�l1� S t���� ^��� <br />/ <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heale� <br />Sink (service/badmop/elc.) <br />Bacicflow preventer <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />urea::; Irap <br />Rn,f d��ins <br />Other <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handlinc� unils <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refric�eration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify Ihat I have read and examined lhis applicalion and know lhe same to be lrue and correcL All provisions of laws and <br />ordinaces goveming this type of work will be complied with whelher specified herein or not. The granling of a permit does not presumo <br />tn give aulhority lo violale or cancel lhe provision of any other slate or local law regulatinc� consWction or Ihe performance of <br />c..nstrucUon. That I am authotized by t owper of lhis property to periorm the �vork for which application is made and I comply wilh lhe <br />Slate ContractorS Layy 18.2�RCW 29G�200 WAC. <br />— �/) — L/� <br />