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P�:R�VIIT APPLICATIt��� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-a810 - FAX 425-257-8857 - www.everetlwa.org <br />SITE ADDRESS <br />� � � r <br />y,r:., , a� i ✓,- <br />LEGAL LOT NO. <br />DESC. ` <br />OWNC-R <br />� r" '/ <br />r,�/�,d.,J tlr, �� ,a U•+ <br />TENANTNANE <br />���uJ;�.� G <br />CONTRACTOR � �-. <br />�/? r' / <br />CONTR. LICENSE # .� <br />r <; j � <br />USE OF BUILDING <br />i � `� <br />WORK DESCRIPTION <br />'�i e' /-�L. v �, : � (� <br />APPLICATIONS ARF ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />PARCEL TAX I.D. # <br />TRACT OR SUlDIVISION # <br />��.':t �;ic��(Lu L b� , �_,;d � <br />CONTACT FOR PERMIT <br />�- �' <br />�O✓.� �b fQ � v i <br />� d �J t,� <br />� <br />NO, I NPE OF FI%TURE OR ITEM <br />Toilel <br />Oalhtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Cblhes washer <br />Waler healer <br />Snk (service/badmop/elc.� <br />BackOow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Othcr <br />wwrceaa <br />G � rt "i �'(9 C <br />i'Y) 1 <br />a -t� <br />PERMIT # <br />PHONE ��� ,��ic7 � j2�� <br />c(,��-3oa-s�n: <br />HEATSOURCE <br />� Eleclric __ Gas _ Other <br />N0. <br />CONTRACT PRICE OF WORK <br />Mtl:IiAIV <br />Tl'PE OF FIXTURE OR ITEM <br />NC — air handliny units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas (ireplace <br />Gas ranye <br />Clothes dryer <br />Rangehood <br />Exhausifan <br />Heat pump <br />Unit healer <br />E3oiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br />I hereby ceriti(y that I have read and examined this applicalion and know Ihe same to he true and correct. All provisions of laws and <br />ordinaces governing lhis lype of work will be somplied with whether speci(ied herein or noL The c�ranting of a permit do^s not presome <br />lo give aulhorily lo violale or cancel the provision o( any olher slale or local law reyulating conslruclion or the per(ormance of <br />construction. That I am aulhorimd by lhe o�vner ol this property lo perlorm lhe work for which application is made and I comply with �he <br />Stale CoilraC.ors Law 78.27 RCW an�d 296200 WAC. <br />