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PERMIT APPLICATION <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 />� <br />LOT N0. <br />TRACT <br />PARCEL TAX I.D. # <br />- ooz. <br />PERMIT A <br />DESC. j' � I I <br />OWNER AODRE55 CITY2IP PHONE ,�_�1 J1 I�, <br />o r., <br />�r-•��9 l►JVEb711�.IT GseP l`I+�o 36z►(�/� � 1�W1, LYI�W41oc[) qtse3�, <br />TENANT NAME CONTAC�OR PERMIT PHONE <br />�c�a ��v I �AY s� �6- a��-os�o <br />CONTFZA/C�TOR AODRESS CITYIZIP �,, P,H/ONE ( <br />CON�% LI ENSEA' CI�� C�G'��P .S c,S- l'.LLIYlt�4"'�,YS-[� SY��7"-EI�F 't�/�-`E�)j,/ �7�c�-`J <br />- -u-�.fsc %�"/ D% i � <br />USE OF BUILDING <br />�filnclw�N1 G►1 /c <br />HE�4T SOURCE <br />_ ElecMc � Gas _ Other <br />WORK DESCRIPTION <br />T6,ro�rrr ( nPRov►�-��t I� <br />NO. I 7YPE OF FI%TURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />KRchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop'etc.) <br />BackAow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />��;� �'�. — <br />�vn-G+� �€stA��7. <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 />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Bailer <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritiy that I have read and examined this application and know the same to be true and correcl. All provisions of laws and <br />ordin2ces governing this type of work will be complied with whether specified herein or not. The granting o( a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating wnstruction or the periormance of <br />construction. That I am authorized by the owner of this property to periorm the work (or which application is made and I wmply with the <br />State ConUactors Law 18.27 RCW and 296200 WAC. <br />`� <br />