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PERMIT APPLICATI4N <br />CITY 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 <br />`�,IG bf�.ir.�' :9��111t� <br />LEG�L LOTNO. BLOCK <br />DESC. <br />OWNER <br />c � �tr�� S�'it�iC�c� � <br />TEN— AN AME <br />./� <br />CONTRACTOR ��IJI��t' � �LC /)"7 G � �1 �� <br />CONTR.LICENSEf VJI'r.I1G?�C,I <br />USE OF BUILDING <br />� l t' ' ' `'�. <br />PARCEL TAl( I.D. M <br />TRACT <br />CONTAC7 f�OR PERMIT <br />:T�' �'�,t'vt�_ <br />ADDRESS <br />1�3.�1 7YC Si SC S C� <br />t.x� �'�'{�C1 <br />HEATSOURCE <br />_ Electric �Gas __ Other <br />WORK DESCRIPTION I�GL([(�"1 -_L f 1 �'� �'cl'� �%/1'1'1 PI �i M <br />�� <br />NO. I TYPE OF FIX7URE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />ShOwer <br />Kitchen sink 8 d�sposal <br />Dishwasher <br />Clothes washer <br />Laundry iray <br />Sink (service/badmop/etc ) <br />Backllow preventer <br />Unnal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other tiL'���'G1��,,E �7Ul��.S � <br />NO. <br />#/�-. <br />�5 ��l�i <br />CITYIZIP PMONE <br />PHONE <br />�17J �SD E'S(, `� <br />CITYIZIP PHONE <br />/lt:llld' `;�,,7�� �L' U <br />�y�/ ���� <br />CONTRACT PRICE OF WORK <br />1� C2�U `� <br />r 1 `.J <br />TYPE OF FIXTURE OR ITEM <br />AIC - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />UNt heater <br />Boiler <br />Relrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 7105 <br />I hereby cerilify that I have read and ezamined lhis application and know �he same to b? true and correc�. All provisions of laws and <br />ordineces goveming this type of work wAI be complied wdh whelher speciLed herem or not 7he grenting of a pertnit does not presume <br />to give authorlty to violate or cancel the provision ot any other state or local law regulating construction or the peAortnance of <br />construction. That I am authorized�by the owner of this propeny to perform the work for which application is made and I wmpty with the <br />Stal Contractors Law 1827 RC and 296200 WAC. <br />�� \ . <br />�_____-- '�' � Z �' G �v <br />