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PEhcMIT 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 />AFPLICATIONS ARE ACCEPTED FROM 8 AM T^v 4 PM <br />SITE ADDRESS <br />�3is �-(�rr�s�„ f�Vej��- <br />LEGAL LOTNO. BLOCK <br />DESC. <br />OW NER <br />� C o i I ��U,o1 K A-� l� <br />TENANTNAME <br />N I� <br />CONTRACTOR <br />C�1NTR. LICENSE R <br />USE OF BUILD�NG <br />PARCEL TAX I.D. A' <br />TRACT <br />ADDRESS CITY2IP PHONE <br />/�oa7 �lf-`' A�� NW �-lihy��,Yd'u3 ��G�4'9r-7�'Yo <br />CONTACT FOR PERMIT <br />ADDRESS <br />HEAT SOURCE <br />�/Eleciric Gas Other <br />WORKDESCRIPTION �Q�l��t eXlST�^�X j-�'D� <br />( (/ <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtuh <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposai <br />�ishwasher <br />Clothes washer <br />�Yaler healer <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinkin� Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />PHONE <br />CITYlZIP PHONE <br />I CONTRACT PRICE OF WORK <br />NO. � TYpE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clathss dryer <br />Range hood <br />Exhausl fan <br />Heat pump <br />Unit heater <br />Boiler <br />Retrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereb7 ceritify thal i have read an4 examined this applicalion and know the same to be true and cortecL All provisions of laws and <br />ordinaces goveming lhis type o( work will be complied with whether specified herein or noL The granting of a permit does not presume <br />to give authority to violale or cancel the provision o( any other state or local law regulating construclion or the petfortnanca of <br />construction. That I am authorized by the owner of this property to pertortn the work for which application is made and 1 compiy with the <br />Sla e Contreclors Law'I18.27 RCW and 296200 WAC. <br />��U-��' �Z��1 3�7�0� ��-�dc,� avn�Y KS °� 3'imlo� <br />Sgnatme of OwnedContractodAulhorized Agenl ate , <br />