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� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CED.�R STREET, EVERETT. WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE AD!`RESS PARCEL TAX I.D. # <br />�(v02N��Si�C�N•�l��1'r posG�79oo�ofoZ <br />LEGAI LOT NO. N� {A BLOCK TRACT OR SUBDIVISION # <br />oesc. �L�G-.��j ts� S�IViEw/fE/F�nl �✓i <br />OWNER ADDRESS <br />2��.yc. ���so,�.����i�ll.-If WfIS�ON 2`�ZN,us,oL � <br />TENANTNAME CONTACTFOR PERMIT <br />��� � £L O�J <br />}�o��l �nTtti y.r+�Sei' ��� S <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEATSOURCE <br />_ Electric � Gas <br />PERMIT # <br />�U t'VV <br />yzs- 7JT- �s'✓� <br />Lru yzs-9��-323� <br />Evc,cfrrl.�.'A, fbZi'3 � <br />PHONE N2SC�7/-'3�30 �L <br />Other <br />E-MAIL <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION , <br />�tyi/s�K��Pt" `R�N�r l���,� (��X23� UNccvElrD �353 S,F <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wasli basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinai <br />Drinking �ountain <br />Floor �rain <br />Grease trap <br />Roo( drains <br />O�her �FGK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />W ater heater <br />Gas (irepface <br />Gas range <br />Clothes Jryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SAlES TAX CODE IS 3105 <br />I hereby ceriti(y Uiat I have read and examined lhis application and know lhe same lo be We and correcl. All provisions of laws and <br />ordinaces c�overning this rype of work will be cemplied with whelher specified herein or nol. The granting ot a permil does not presume <br />to give aulhority to v�olale or cancel the provision of any other state or local law regulaling cnnslruclion or the performance ot <br />conslruclion. Thal I am aulhorized by the owner o( this property lo perform lhe work for which applicalion is made and I comply with lhe <br />Stai�-C nlraclors Law 1�27 RCW and 296.200 WAC. <br />���He ��l/Z/�!� `�p—Q/ <br />SignaWre of Owner/Conlraclor/Authorized Agenl Dale , <br />,'L <br />