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PERMIT APPLICATION <br />CITY OF EVERETT PER�JIIT SERViCES <br />3200 CEJAR STREF.T, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 -- www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />SITE ADDRESS ��.1�� ��� <br />� , r � � r—.wr� � . . <br />PARCEL TAX I.D. # <br />LOT N0. I BLOCK � l'RACT OR SUBDIVISION # <br />OESG. `� <br />OWNEH (�lI 1���-i � � E�1 ' � � <br />� '�--�C,1-1jv� <br />TENANTNAME <br />P�� I I� <br />ICONTACT FOR P[RMIT <br /># <br />�� ZS� ��� <br />PHONE <br />E•MAIL <br />TRA 7 � A�ORESS cnrrnr rnvn� <br />A1,,L��, ci��t�,��}���-� i"1Nt�:1-1�1��1��1�� �L�or�i'C� �-��-��7`1`�-3-�Ji <br />CONTR. LICENSE N ;�i L�-� (>f� ^T!� <br />AwNr�c�Tu�-c��v �-��.� � <br />USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br />�—�GVL•*C�I��[��`��--� _Eleclric_ Gas_Other I <br />WORKDESCRIPTION I��rnC�� � <br />ir���� ���1� ��1G ��F ��� lU�� <br />NO. I TYPE OF FI%TURE OP ITEM <br />Toilet <br />Ba�htub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clotl.es washer <br />Water heater <br />. Sink (service%bar/mopletc.) <br />- Backllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Rool drains <br />�— - O�her _ - ------ <br />�2_ctl�.cl CZccwF��=,c����4�44�� cF ���,cic��lc.� <br />C �� �C�Y�k i'�,� , �! � ��-�i � 01 Li.CI �cG� t � -c� <br />N0. I TYPE Of FIXTURE OFi ITEM <br />NC — aIr handling uni�s <br />Fo�ced air systems <br />Gas piping <br />� Water heater <br />Gas lireplace <br />Gas range <br />Clothes dryer <br />Nange hood <br />� Ezhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Reirigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />I hereby ceritily Ihat I have read and ezamined ihis application and know Ihe same to be true and correct. All provisions of laws and <br />ordinaces 9nveming this lype ol work will b� complied wi�h whether specified herein or noL The granting ol a permit does not presume <br />to give authority �o violaie or cancel Ihe provision ol any other state or local law regulating construction or ,he performance oi <br />conslruction. That 1 am authorized by the owner o1 this pmperty Io pedorm Ihe work lor which application is made and I comply with the <br />Stale Cop�ractor�aw 18.27 ACW and 296.200 WAC. <br />T <br />