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PERMIT APPLICATI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everattwa.ag <br />APPLICATIONS ARE ACCEPTED FROM ! AM TO 4 PM f/� 3 0•.�6 <br />SITE ADDRESS PARCEL TAX I.D. t PERMR • <br />?�S l Z 1-!i l� S{�'i'��k <br />LEGA LOT O. BLOCK TRACT <br />DESC. <br />OWNER ADD SS j� � <br />�tr�i�, d Grieeld� rl'lar�n�z 3gs��+�►h S�-r�e.�k ev��11 �tX�q 3�a-��b <br />TENANT NAME CONTACT FOR PE IT p�� <br />C��p QS G�oaV�{, �U-1'Y�e 0.S �.1oor�f, <br />CONTRACTOR ADDRE3S cmmP w�oNe <br />CONTR. LICENSE N <br />USE OF BUILDING <br />�,lSid�-�i G <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basfn) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Uap <br />Roof dralns <br />Other <br />HEAT SOURCE CONTRAGT PRIGE OF WORR <br />,_ Eiectric �j, Gas _ Olher <br />NO. I TYPE OF FI%iURE OR rtEM <br />A/C — air handlinp unils <br />Forced alr systems <br />Gas P��9 <br />Water heater <br />Gas Biepl�s <br />Gas rarpe <br />Cbthes dryer <br />Ranpe hood <br />E�austfan <br />Heat pump <br />U�k heater <br />Boiler <br />Re(rigeratlon <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS ]10'J <br />I hereby ceritiy that I have read and examined thfs applicadon and know the same lo be hue and corrocl. All pioviaiorq of lawa and <br />ordinaces goveming this type of work will be complied wi'h whether specifled herein or rat The prentkg of e pertnR does tal presume <br />to give authority to violate or cancel the provision of any other stn!e or locel lew repulatlnp constructbn or the perlortnanoe o( <br />consWcUon. That I am authorized by the owner oi lhis property �o perfortn the work for which epplicatlon is made and I comply wflh fhe <br />SSate Contractors Law 1�.27 R�W and 296.200 WAC. <br />