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PERMIT APPLICATION <br />CITY OF EVERETT FERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, bVA 982:i1 <br />425-257-8810 — FAX 425-257-8857 — www.eveiettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SIT� ADDRr"SS � <br />^\ <br />LEGAL LOT NO. <br />DESC. <br />OWNEft ^ <br />G� /- /� <br />TENANTNAME <br />�N �ACT R�` ��'� �� �/ <br />�' � ��1,�� LU�� <br />CONTR. LICENSE p '� <br />hi_�_ i,t) <br />U5E OF SUILDING �� <br />�, , <br />.�)%'f (:�/'`f-t <br />WORK DESCRIPTION <br />/flc-_ <br />PARCEI. TAX I.D. # <br />TRACT OR SUBD�VISION 7! <br />I o-�J �h�N��S/, ��� <br />CONTACT FOR PERMIT � <br />� -- �� <br />� �'��� � <br />,ADDRESS . <br />��u W1 � i R-s^ � <br />� il��:y�i°�; <br />' u �' 7 !'4� ✓ F�`l7—�� < <br />�'. ���.�1 fi�l5/1 <br />�. ;iL, � '� ! ^ <br />i <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toile� <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clo�hes washer <br />Waler heater <br />Sink (service/6ar/mop/etc.) <br />�ackflow preventer <br />Urinal <br />Drinking Fountain <br />f=loor drain <br />Grease lrap <br />Roof drains <br />Other � <br />PERMIT # <br />�C i L � �'CJU <br />�o: �� �a�� �vt,t_fti,�-, <br />PHONE � <br />' `�zs=�S �-�3�v <br />I� )/ E-MAIL . <br />C ,� �'� .. <br />HEATSOURCE <br />Electric �Gas _ Other <br />U L�,�i49�%zn <br />� <br />;,_ <br />F'HONt � � C'/,�/, <br />i y '- �~� <br />�'�/,//c �- jv,✓,ir'' f! <br />CONTRACT PRICE OF WORK <br />�(,,� `f • ��i l.� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling uni�s <br />Forced air systems <br />�as Fiping <br />Water healer <br />Gas fireplace <br />Gas ranye <br />Clolhes dryer <br />Ran�e hood <br />Exhaus't fan <br />Heatpump <br />Urit heater <br />3oiler <br />RefriGeralion <br />Woodslove <br />CITY OF EVERETT LOCAL SALES �fAX CODE IS 3105 <br />I hereby certify Ihat I have read and examined lhis application and know She same lo be irue and correcL All provisions of laws and <br />ordinances governing ihis Iype of r,�nrk wi0 be comp!ied with whcther specified herein or not. The granting of a permi� does not presume <br />to give authority to violate or cancel ihe provision ot any other slate or local law regulating conslructi�n or the performance of <br />construction. T t I am authorized by thz owner of ti;�s property lo perform the work for which application is made and I comply with the <br />State Conir clor aw .27 RCW and 96. 0 WAC. <br />.- i,.���.: , �� , �' - !0 2 /G <br />��,� • �/ <br />, <br />���� Il4�kti,•�,wl ��r.,�, �u�e 2,� � <br />