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PEr�MIT APPLICATIOi�! <br />CITY OF E`✓ERETT PERMIT SFRVICES <br />3200 CEDAR �TREET, EVERETT, WA 98201 <br />425-257-881Q — FAX 425-257-8857 — vsNw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />�Z` 1 1- { `L <br />LEGAL LOT NO. . � <br />DESC. I^I, 1�7 c� 1 <br />� <br />BLOCK <br />PARCeL TAX I.D. # <br />DC%��-,�l I�iS���O!`-��' <br />TRACT <br />PERMIT <br />TENAN7NAME CONTACiFORPERMIT ' PHONE <br />� �C� �✓It' �� <br />��� R'It F- '�,�1�� �N�,1�,� t� �de��1v� ..�� 6^��� �����-�, ��s )U�tZ�- l o�o�n x IC� <br />CONTRACTOR �1py���t-��u �iuilders,ii�l(. ADD� � CITY/ZIP �PHONE <br />, i��{ �:cr -�z:I��nc�eri,�N� ����'� ss (�c�:)�s��--��ce <br />CONTR. LIC[NSE #`j, i �S"( E�l '�)� Z,�J� <br />USE OF BUILDING <br />HEATSOURCE <br />X Electnc _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />�.Z�S� tx;v <br />WORK DESCRIPTION Ti'Ni�»�1 ll+�}'�c.n �wtn� .� ��v� � xi'��i�vu�\ :'t�t� S�• �j;l�•� G��tcC �'oY ,.ISC c�S cnh cY�i � <br />>���c�z��yif;t« lv1c��v�ilccr �nlencrYeviovaticvi5 �viV+'cl�ic��v�ti.vy,i��IIS�Q1u�cwr<<r�:(z)v�-tw <br />ltlik�, l,4'.en�riA,c i"�i�"^C�"^(lC YZ��IGV�Nc,<��Si'tV�C) �Nte✓�N�lJit(S4v+nri-�n�c ��v2Y tki=tiVti�iXf�y���� <br />'..i�'.liti�,,�•l t,,'cvcd exi :1il�i� vr� F �lvr i��:;c�vtala�� �Jal • <br />J <br />NO. � TYPE OF FIXTURE OR I7EM <br />Z Toilot <br />Bathtub <br />� Lavatory (wash basin) <br />Shower <br />1 Kitchen sink 8 disposal <br />Dishwasher <br />I Clolhes washer <br />Laundry lray <br />F.,, Sink iservice/bar/mop/elc.) <br />Backilow preoenter <br />_ Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />�L \` � <br />/\� n� �f �ti <br />\ �� <br />NO. I TYPE OF FIXTURE OR ITEM <br />FVC - air handling unils <br />Foroc�d air systems <br />Gas piping <br />,� Water heater <br />_ Gas fireplaco <br />Gas range <br />1 Ciothes dryer <br />Ranae hood <br />� Exhausttan j <br />_ Flea� pump <br />Unit neater //�`� <br />_ Boilcr <br />Re(rigeration ,' <br />Woudstove ' <br />Olher <br />CITY OF EVEREiT LOCAL SALES TAX CODE IS 3�05 <br />I hereby ceritify that I have read and examined this application antl knov✓ the same to be true and wrrecL All provisions of laws and <br />ordinaces governing Ihi� type of work will be complied wilh whether specified herem or not. The grenting of a permit does not presume <br />W give autFonty to violate or carcel the prwision of any other state or Incal law regulating wnsWction or the peRormance of <br />constru�:ion. Thzt I am author2ed by the owner of this oroperty to perform lhv work for which application is made -+nd I comply with the <br />State�COnlractors Law 18.27 RCW and 290.200 WAC. <br />'1 <br />�" � �11n � �I'�.U.�-c� -d- I�-i�`L <br />Lu. <br />Signatur f Own ontractodAuthorized Agent ate / <br />\I� <br />