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F'ERMIT 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 <br />SITE ADDRESS • <br />i � � � N1 Q ��,� <br />LOT NO. <br />APPLICP.TIONS ARE ACCEPTED FROM 8 AM TO 4 �:d <br />PARCEL TA:( I.D. # <br />BLOCK � I TRACT OR SUBDIVISION ii <br />I`�-0� <br />O/-DO/ <br />DESC.r I I — <br />OWNER ADDRESS CITY2IP PHONE <br />�1A� /G/5l /�'la�ldro,�� �v""`�� �rzs= 3i7- yi�� <br />�Ti9/�N /"i a�'v��so�-, ��< <j�Zo3 <br />TENANT NAME � CONTACT FOR PERMIT PHONE <br />l. V IV 1 KHIi I V R <br />Cy /a,� �/..- � � /� s �- 5 ��� <br />CONTR. LICEN�E N _ . � _ _ . <br />� <br />USE OF BUILDING <br />' / (' S <br />E-MAIL <br />36oi ���,����� � v�;��j- <br />98Z-o/ <br />HEATSOURCE <br />� Eleclric _ Gas <br />WORK DESC TION <br />,�L'nIDL`C (i`i( �G�I"i�r�L� <br />.�,sf// <br />, � ��; t�<;,,y:� <br />NO. I TYPE OF F�XTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />Sink (service/bar/mop/elc.) <br />Back(low preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Root drains <br />Olher <br />yZ,s=-z S5'-zi�/ <br />CONTRACT PRICE OF WORK <br />Other � / $ / ��/ <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C – air handlinq unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woadstove <br />Ofhe: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby cerilify Ihal I have read and examined thls applicalion and know lhe same to be irue and correcl. All provisions of laws and <br />ordinaces goveming lhis type of work will be complied wiih n�helher specified herein or noL The yranting of a permit does not presume <br />to c�ive authorily to violate or cancel the provision o( any other state or local law �egulaling construcliun or the performance of <br />construction. That I am authorized by lhe owner of lhis property lo periorm the work for which application is made and I comply with ihe <br />Stale Cont%ra tors Law 827 RCIN and 296.200 WAC. <br />/��" //- ;%� �- ��``a `% <br />