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l <br />PERMIT APPLICATIOIV <br />C17Y OF EVERETT PERPJIIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-�57-8810 — FAX 425-257-�857 — wwe�.everettwa.org <br />ra �� j APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE AUDRESS PARCEL TAX I.D. tF <br />r _--�,-"1– ,\. .�. ) r �� , . � i � \ . ; .\ � �� % . . .. i l , . 1, ri. . . . � � � ; <br />LEGA LOTNO. BLOCK TRACT �� <br />oesc. �� (� '':t C�_?? ��.i?^ 1��<� :-i �����:;.:1 ��'� �-r- <br />OWNER ADURE55 CITY2IP PHONE <br />`,,,/',• ,,,� lf: � ,a _> > <br />� <br />J <br />5-31�7 <br />P� � �� - � <br />PERMIT # !/ <br />� �6� C�7 <br />TENANTNAME <br />(�L�1�E:_ <br />CONTRACTORi� � i�;�; •'•;� '.`:. ., ^ � <br />CONTR. LICENSE fi . <br />C;b<<r- �'�` <br />USE UF BUIL ING <br />�� � l i � <br />WORK <br />I�������� <br />CONT�CT FOR PERMIT PHONE <br />1' •' �- I� :. .`pci-' `.t . c ��c ;^��° - .. . :_� i <br />C G, AUDRESS �� ��,� : � n, :,� CITY2IP PHONE <br />�� <br />_ `a��I Y � <br />• i; :.1� <br />c � , . . . !� , , �, .. �., 3c� — c�-� � — ;' <br />NO. I TYPE UF FIXTURE OR I'fEM <br />`= Toilel <br />8athlub <br />�'_ Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />`_ VJater heater <br />� �_ Sink (servicelbadmop/etc.) <br />Backflow preventor <br />Urinal <br />Drinking Fountain <br />F�oor dreir <br />Grease trap <br />Roof drains <br />Olher <br />— HEAT SOURCE I CONTRACT PRICE OF WORK <br />Eleclric �� Gas Olher <br />, � �� <br />i�3 y ''� <br />___- -- <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C – air handling unit� <br />Forced air systems <br />�; Gas piping <br />Waler heater <br />Gas fireplacr. <br />Gas range <br />Clothes dryer <br />Rango hood <br />� Exhaust ian /i' <br />Heal pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY �F EVERE?T LOCI�L SALES TAX CODE IS 3105 <br />I hereby cerilify lhat I have read and examined lhis applicalion and krow lhe same to be true and correcL All provisions o( laws and <br />ordinaces yoverning lhis type of work will be complied with whether specified herein or not. The granting of a pemiil does not presume <br />to give aull:oriry to violalo or c�ncel tho provision of any other slate or local law regulating construction or the performnnce of <br />construction. That I am authorized by the owner of this property to perform the work tor which applicaGon is made and I comply wilh tlie <br />Stale Conlraclors Law 18.27 RCW and 296.200 WAC. <br />: .j � �� _ <-> " � <br />Signature o( OwnedContraclodAuthonzed Agent Dale <br />! <br />^` _�� � . '�� <br />