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PERMIY APPLICATION <br />CITY OF EVER�TT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-6857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FflOM 8 AM TO 4 PM <br />SITE ADDiiESS <br />/ C �t� r ,a, i�V�?- <br />LEGAL LOT N0. BLOCK <br />DESC. � <br />�5 <br />OWNER <br />9�71a� � • /�/Or'.r`I SOl� � <br />TENANTNAME <br />CbNTRACTOR <br />Hom� !';��h P/�" <br />CONTR. LICENSE # <br />USE OF BUILDING <br />/�om� <br />°ARCEL TAX I.D. # <br /># <br />s <br />f /?lut'��r� � <br />So rrr e <br />HEATSOURCE <br />i� Eleclric _ Gas _ Olher <br />W/�pRK D>ESCRIPTION c �� ,JX /` L/eG 1, <br />/\e�C/(.lG� E�J�/.,�Ii L9 7- �, ;G tC <br />�i <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toile� <br />Ballilub <br />Laaatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Roof drains <br />Olher <br />Wl fl: i/c:6'c� <br />2�i�- s-� <br />D�-U3 <br />98203 �f1.; 3/' -�jl <br />��r-�m,ar�dertt� �msi <br />3/7-�/02 <br />CONTRACT PRICE OF WORK <br />2 �81�-L' l �UG �� <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler hea�er <br />Gas fireFJace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boilor <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVEREI � LOCAL SALES TAX COOE IS 37U5 <br />1 hereby ceritify that I have read and examined ihis application and know Ihe same to be true and correct. All provisions of laws and <br />ordinaces governing ihis type ot work will be complied with whelher specilied herein or noL The granting of a permit does not presume <br />to gi�e aulhority to violate or cancel ihe provision ol any other state or local taw regula�ing construction or the perlormance of <br />construction. That I am aulhorized by Ihe ewner of ihis property to perform the work for which application is made and I comply with the <br />State Conlractors.Law 78.27 RCW apd 296.200 WAC. _ , . <br />✓OO//JP� � <br />/� <br />