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PERMiT APPLICATION <br />t;ITY OF EVERET�' PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.evP: �<iwa� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & <br />SITE ADDRESS <br />.� <br />L`tGAL LOi N0. <br />DESC. <br />OWNER <br />�✓��rr <br />TENANTNAME <br />�/D �� <br />BLOCK <br />PARCEL TAX I.D. # <br />TRACT <br />AODRESS <br />r T/io.e i 7- <br />CONTACTFO PERMIT <br />CONTRACTOR . AOORESS <br />a�✓� � s�.����� ,�,��s%�� �..�- �s� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DcSCRIPTION <br />`� �.Q Q"` C b i� G <br />U��;,-_.� . <br />'I1 ���,�'��1;;,'; <br />, �; <br />,^�, �,; <br />�.U,,, <br />�' �_. ,�Frl . ... <br />_aS_aB ?�.-,•- <br />accearEo <br />PE�q7IT � <br />�Y�s�3o3 � i a � <br />�II- I � CV7Y21 <br />,ct,�-.r�� <br />HEATSOURCE <br />_ Electric _ Gas _ Olher <br />� �N�..� 1 �--+ <br />NO. I TYPE OF FIXTURE OR ITEM <br />� V Bathtub <br />Lavatory (wash basin) <br />� Shower <br />i = Kilchen sink & disposal <br />Dishwasher <br />� " Cblhes washer <br />� Lzundry tra/ <br />� Sink (service/badmop/etc.) <br />� Backilow preventer <br />Urinal <br />�i Drinking Fountain <br />�� Floor drain <br />Grease trap <br />� Roof drains <br />Other <br />� <br />� <br />PHONE <br />PHONE tt Z� �' <br />�o9g <br />CONTRACT PRICE OF WORK <br />��,^-�% �v NI P <br />O �L/�i1'i-liJl/�r <br />270�' �6"���C �'flz�/ <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handlina units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Ranr,e hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />� CITY OF EVERETT LOCAL SALES TAX COOE IS 3'105 � <br />��. I hereby ceritify that I have read and examined this aoplication and know the same to be true and correct. All provisions of Iaws and <br />' ordinaces governing this type of �vork will be complied with svhether specified herein or noL The granting of a permit does not presume , <br />to give authority :o violate or cancel the provisicn of any olher slate or local law regulating construction or the performance of I <br />construction. Thai I am authorized by the o�mer of this property to perform the wcrk for which application is made and I comply wiih the � <br />State Contractors Law ?8.27 RCW and 296.200 WAC. • ' <br />- Z/- c7� <br />� <br />u <br />