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� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 96201 <br />425-257-8810 - FAX 425-257-8857 - www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM d'�17-� l <br />SITE ADDRESS <br />S s-S e�se.� !l D . <br />L[GAL LOT N0. BLOCK <br />DESC. <br />OWNER � <br />aovA� w;,�Ao�✓ t Aoo,r <br />TENANTNAME <br />;�,5 <br />PARCEL TAX I.D. N <br />p p20o 0�� 00 <br />rruCr <br />ADDRESS CI <br />St5 �}Md1eS�d QQ E�a <br />ICONTACT FOR PERMIT <br />�I%M QOw�-i.�.% — <br />CONTRACTOR DDRESS <br />�G�iR�lct fi/� �rorou►.►� <br />/�oQ�X��2Q <br />CONTR. LICENSE R�`L� � FP � � 2 L � <br />USE OF BUILDING <br />��A+�Nt/1 � 1Krwy <br />WORK DESCRIPTION <br />ApA �o Heqps To <br />HEATSOURCE <br />Electric Gas Other <br />RMIT if <br />_ � -Da' <br />PHONE <br />Zob-Z��-9 y <br />CITY2IP <br />�re s �e� <br />uN�urr!dc, 6� Nt,yv MeLzq.,i;Nd. <br />NO. I TYPE OF FI%TURE OR ITEM <br />Tailet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mopletc. ) <br />Backflow preventer <br />Urinal <br />Dnnking Fountain <br />Floor drain <br />Grease trap <br />Roof drams <br />Other <br />PHONE <br />2 06 -�.Bz-bG3� <br />O <br />CONTRACT PRICE OF WORK <br />1eo <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhausifan <br />Heal pump <br />Unit heater <br />Boiler <br />Refngeration <br />Woodstove <br />Other <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby ceritify that I have read and examined this application and know the same to be irue and correct. All provisions of laws and <br />ordinaces goveming ihis type of work will be complied with whether spedfied herein or nol The granting of a permit does not presume <br />to gNe authonry to violate or cancel the provision of any other stale or local law regulatin9 conslrudion or ihe perfortnance of <br />consW ction. That � am authorized by ihe owner of this propeAy to periorm the work for which application is made and I comply vnth the <br />Stale ConiraGbrs Law ]8.27 RCW and 296200 WAC <br />