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F __RMIT APPLICATI� N <br />CfTY OF EVERETT PERMIT SERVICES <br />3200 CEDAR 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 ADDRESS / y PARCEL TAX I.D.( '#� 7 <br />J��� `�)YC,�7C.� .�Y��. �l�H 3 i i.>j 3�-l� / L��� <br />LEGA LOT NO. p BLOCK TRACT OR SUBDIVISION N <br />DESC. �� Y�. �t,. bj' IU ,j ✓ r�, <br />OWNER � i ADDRESS CITY/ZIP <br />/-�,�. �. �'��L--��-��,�. f P�����c�sy,//,���(t�, y���s <br />TENANTNAME <br />CONTACT FOR PERMIT <br /># <br />PHONE <br />y�5 -353 -,�.z� <br />PHONE <br />• •• <br />��. �. <br />,f'/I <br />CONTR. LICENSE # �/ GU /C�L� <br />USE OF BUILDING <br />HEAT SOURCE <br />� Electric Gas Other <br />i Y"-�7;JiPs.;��, — — — <br />DESCRIPTION <br />• �x� )1C�L1%C�� � c� LX;'(7J�lZ�� :�i 0 / � <br />1� ,-�� <br />' ''��f: �' �;� 1 1 t' � ) C''� _/(�(: ��� <br />� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toi�et <br />6athtub <br />Lavatory pvash basinl <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />6ackllow preventer <br />Urinal <br />Drinking �ountain <br />Floor d�ain <br />Grease trap <br />Roof drains <br />O�her <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FI%TURE OR ITEM <br />AIC — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas freplace <br />Gasrange <br />Clolhes dryer <br />Ranye hood <br />Er.haust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY UF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify Ihat I have read and examined this applicalion and know the same to be true and correcl. All provisions of laws and <br />ordinances governing this rype of work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />(o give authority to violate or cancel Ihe provision of any other state or local law regulating conslruction or the performance of <br />conslrudion That I am au!horized by the owner of this propehy lo perform Ihe work for which application is made and I comply with the <br />State Contraclors Law 1827 RCW, a�d 29�.200'JVA�� � <br />� /C� <br />, � <br />' �.1; /, � . :� � r� ,. . � "/, <br />�Z <br />