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PEk�1111T APPLIC�ITIO�i <br />CITY OF EVEREi'T PERMI t SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wwv,•.everettwa.org �_3 �`� � <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTEYS <br />SITc ADDRES� <br />�� D �i <br />LE�A LOT NO. <br />DESC. �eC � <br />OWNER <br />l�vsv.+ Y—�� <br />TENANTNAME <br />CONTRACTOR ULt U I <br />CONTR. LICENSE # <br />USE OF BUILDING <br />BLOCK <br />J� � g <br />I PARCEL TAX I.D. # <br />I �$�50.5'1Dz�f0 <br />TRACT �LE7� O.S��,�A%I� <br />ERMIT #; � <br />1 � . f;��,�. <br />oa5 -c�;.��;� � <br />ia , r , o s. Co� sE % <br />CONTACi FOR PERMIT <br />� W � � ADDRESS CITY2IP <br />S0.�'riL 0.$ G,k�F7U-�. <br />HEATSOURCE <br />a e � Eleclric _ Gas _ Other <br />� � <br />� ��1, n, 'l; I � <-'��� <br />NG. I TYPE OF FIXTURE OR 11EM <br />Toilel <br />Bath��b <br />Lavetory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothe ; washcr <br />Laundry tray <br />Sink (eervice/bar/mop/etc.) <br />Backflow provznter <br />Urinal <br />Drinking Founcain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />PHCNE <br />PHONE <br />CONTRACT PRICE OF WORK <br />N0. I TYPE OF FIXTURE OR IT�M <br />A/C — air handling unils <br />Forced air systems <br />Gas pipinc� <br />W aler heaier <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unil heater <br />Boiler <br />Re(rigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �705 <br />I hereby cer,tify that I have rcad and examined this application and know the same to 6e tr��e and covect. All provisions of lews and <br />ordinaces goveminc� ;his type of work will be complied wilh whether specified herein or not. The granling of a permit does not presume <br />to give authonty to violate or cancel lhe provision of any olher state or local lavr regulating conslruction or the performanco of <br />construction. That 1 a� aulhorized by lho owner of this properly to pertorm tho work for which application is made and I compty wilh the <br />Stale ¢qitrar,tors L�v 1$r$i RCIy and 296,200 WAC. <br />�%ti��.��!!�/ s <br />