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1 <br />PERMIT APPLICATIUN <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 />1 �� � �� �� �� -{ q� z APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �"" 6`�� <br />SITE ADDRESS �, PARCEL TAX I.D. # PERMIT # <br />�i.^� I <br />��?'�il �%niL�i„�.-.r !-�.n+ �ii,r.. N i,'�fl .:("jA4'1i7f7-IDI(�/�'!! . � /i�)�-iU�i j� <br />LEGALI LOT NO. I BLO <br />DESC.� <br />OWNER <br />I ��, t' �-�.; i,� ��1L <br />TENANTNAME <br />j�;-���. o��,��� <br />NTR T <br />�-i-D i'N �. C7lU Yl �'_✓ <br />� CONTR. LICENSE # <br />I <br />� USE OF BUILDING <br />,� <br />�1 �5 i �lC�� 1 �" 1c�� <br />TRACT OR SUBDIVISION N <br />��J.��l� J��fll�l" <br />CONTACT FOR PERMIT <br />3�E/ua: i � <br />���1"�0�1 I��V����.-tU/W �1 �2� .�i��1����J•�� <br />1 I ��._ �(✓1 <br />HEAT SOURCE <br />� Electric _ Gas _ Other <br />PHONE �� -7,-1�{ ��51 L <br />2.^-4� "i7�i (GYN3 <br />E-MAIL Stlu�ll.�uc,l.c <br />CONTRACT PRICE OF WORK <br />I�i�1 — <br />WORK DESCRIPTION <br />Fl���-� -7 i�c'�?✓�t�r�� rc' ���;m;�1 �2<rS���i�.�l :i�fl�i/5 iac��.i YlCW �K�CYIU{� <br />� / <br />.1�,�,� <br />NO. I TYPE OF FIXTURE OR ITEM <br />9 Toilet <br />�_ Balhiub�•,,...o_� <br />,_J_ Lavatory pvash basin) <br />Shower <br />1 Kitchen sink 8 disposal <br />� Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />BackBow preventer <br />Unnal <br />Drinking Fo�n�ain <br />Floor drain <br />Grease trap <br />Roof drains <br />�9. Other t,: r c��.� � rr�,�.+ <br />i, i <br />1 ��,��[r.+lnr ii�e�.�i. cl�:�/. <br />— I� <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 firepiace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(ngeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby cehify that I have read and examined this applicaUon and know the same to be true and correct. All provisions o( laws and <br />ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give aulhority to viola�e or cancel the provision of any other slate or local taw regulating construction or the performance of <br />consiruction. That I am authorized by the owner of this property to perform ihe �vork for which application is made and I comply wilh ihe <br />Sta��(�actors Law 18.27 RCW and 290200 WAC. <br />� �: . / / , <br />1/ <br />� <br />