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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org %�- 7- `-a % <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />� 1'n/�cl� a�T S� F"�'Z�/f � <br />LEGAL LOTNO. BLOCK <br />rbhelz� 1�7AlC�Z <br />TENANTNAME <br />12vben�' m r� � �'rC <br />CONTRACTOR /J [+� N u� <br />� <br />CONTR. LICENSE p <br />USE OF BUILDING <br />PARCEL TAl( I.D. # <br />TRACT <br />`aa i�znac�o� ��io <br />� l��i�:, <br />� �e,� tt U� �>s.��J <br />CONTACT FOR PERMIT <br />JZ�r�/Y7JP�/t7�ADDRESS 6 �„��I,{,,,� <br />HEATSOURCE <br />�Eleclric _ Gas _ Other <br />CU7v� -� <br />PHONE <br />CITY2IP PHONE <br />�',.e,�,tt 9�zo3 <br />� <br />:� 3So-.3//7 <br />'2S)3so-3//' <br />CONTRACT PRICE OF WORK <br />WORKDESCRIPTION N�� H G-uLL �Ai'h �i7 �'X�,S�iru� �rliRW�jP�Out l3ui(.c��ny <br />J' y( � i�_] �i L' Ru({'7E `/aMi�,r %LW�`r <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Waler healer <br />Sink (service/badmop/elc.) <br />BackOow proventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas tireplace <br />Gas range <br />Ciothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigerelion <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify Uial I have read and examined this applicalion and know the same lo be true and correcL All provisions of laws and <br />ordinaces govemin� this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give 2uthority lo violale or cancel the provision o( any other state or local law regulaling conslruction or the performance of <br />construction. That I am authorized by tlie owner of this property to perform the work for which applicalion is made and I comply with the <br />Stale Conhactors Law 18.27 RCW and 296.200 WAC. <br />,�y_ .��� i;r�„��,�--� <br />��� <br />