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PtRMIT APPLICATI�,N <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 ��� CJ � � PARCEL�X I.D.�# <br />o� R�� f�� oo�-f> 7� ot7�6 <br />LEGAL LOTNO. BLOCK TRACT <br />DESC. l%- I� I`� �] 3� L✓f-�2P�"i' �1 V- f'( <br />OWNER ADDRESS � CITY/ZIP <br />('�v L�Ut=�>pa�,r�.� Q larvSTR uc7c.� LLL <br />TENANT NAME CONTACT FOR PERMIT , <br />il.�Ic�r� ���-r.✓ ���o�Sc�K�9 <br />-1-ti—O(o <br />PHONE <br />ti2S z � Z� ��/o Z <br />CONTRACTOR T ADDRESS CITYIZIP PHONE <br />�'�20 �v_=w)��:.w l�.O. �ox r��2L �7"<<C. `{�i-Zi2-1�1�5� <br />K �rv'Jrl2 UCT+A/ � � �- �- <br />CONTR. LICENSE 7! f IwOt �C �d LZ �' C. <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />�'� � (����'� Eledric Gas Other <br />WORK DESCRIPTION <br />� ,r.r o <br />c��0 ��9-�'a ,� � �A� �t= l�f °i'���<<�� <br />PLUMBING i MECHANICAL <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washcr <br />Water heater <br />Sink (service/badmop/elc.) <br />Backflow preventer <br />Urinal <br />Drinkin� Fountain <br />Floor drain <br />Grcase lrap <br />Roo( drains <br />Olher <br />��, � TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas rangc <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this application and know the same to be tr�e and correct. AI� provisions oF laws and <br />ordinaces governing this type of work will be complied wilh whether sp��cified herein or noL The granting of a permil does not presume <br />lo give aulhorily to violale or cancei the provision o( any other slate or ;ocal law regulating construction or the periormance of <br />construction. Thal I am authorized by lhe owner of Ihis property W�erform the work (or which application is made and I comply with the <br />Stale Cur11[aEors Law 18.27 RCW a�d 296.200 WAC. <br />