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PERMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEREl'T, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />pPPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PHi �" �� —� � <br />SITE ADDRESS � PARCEL TAX I.D. # j P�RMIT # <br />LOTNO. BLOCK TRACTORSUBOIVISION# <br />!9 � Do 7E4 D-oe LvEec�, �iv A'PLIi'r <br />.. ���-,�c� ..-y� pr:., <br />�Zutr � Ezik gte.s.�s �7iN 3cn.i a*� �� EvEecr 4nJc5 yzs3sc, c�-a�l <br />TENANTNAME CONTACTFOR PERMIT PHONE <br />�� 1 I (r,.�,,�tic,s'` ) �'c.Mu'S (JU�S't��n,� �Ac� i�k7[,r 3Ec�C�j-4�l <br />I-'� E-MAIL <br />CONfRACTO ADDRE55 CITY2IP P ONE <br />�C�)IJE� <br />CONTR. UCcNSL # <br />USE OF BUILDING <br />N1 F <br />WORK �ESCRIPTION <br />R�Ptr10E �'Cc'F <br />NO. � TYPE OF FI%TUHF.OR ITEM <br />Toile� <br />Dalhtub <br />Lavarory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Ciolhes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease irap <br />Roof drains <br />otner =cv�[ VGtilr,i_ <br />� -�iu_ ;om 5r. s.g <br />HEATSOURCE <br />�v�nEA %6z��� <br />x Electric _Gas_Other <br />yzs-3s�-z�z y <br />CONTRACT PRICE OF WORK <br />.�3� SvD. 00 <br />NO. I TVPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas lireplace <br />Gas range <br />Clolhes drycr <br />Rangehood <br />Exhaustfan <br />Hea� pump <br />Uni� healcr <br />Boiler <br />Refrigeration <br />Waodslovc <br />CIN OP EVERETT LOCAL SALES TAX GODE IS 9105 <br />I hereby cerilify Ihal I have read and examined Ihis application and know the same to he true and co«ect. All provisions ot laws and <br />ordinaces goveming �his type of work will be complied wilh whether specitied herein or noL The granling of a permit dr,es not presume <br />to yive authority to violate or cancel Ihe provision of any other state or local law regulating constmction or Ihe performance of <br />consimction. That I am au�horized by the owner ol �his property to pedorm ihe work for which application is made and I compty with ihe <br />SWte Contractors Law 1827 RCW and 296200 WAC. <br />��«.� G�-�� `/ z 9 -U j <br />SignaNre ol wnedContractodAuthonzed Agent Date �/ <br />2 <br />H <br />