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--( ' <br />PERMIT APPLICATI4N <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 y��"'� � <br />SITE ADDRE3S PARCEL TAX I.D. N PERMIT / <br />� �/y ��kcc 9��1 I'oRoK-ocU <br />LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br />DESC. <br />OWNER / M�� ADDRESS CITY2I�P/ PXONE yz �_J�(�7 � <br />�i1i'pr� �Jl^!+^�0�^ 3�/Y D�� L 1�'!" !UW/ TJ3l�S <br />TENANTNAME I CONTACTPORPERMR PHONE <br />�oRfancr� o� 1% l2p �de' l L• L. L,•� <br />CONTR. LIGENSE N G v��2 �� L a/ 7�A <br />L <br />USE OF BUILDING <br />Re Sl �ev�r,. <br />WORK DESCRIPTION <br />� �„� c,,J�.. �4-� <br />'� S �3 F,� �-� Wz�� <br />HEAT SOURCE <br />_ Electric <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Back9ow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />Gas Other <br />rnvnc Z r 7 � <br />��U� � y <br />SS2� <br />CONTRACT PRICE OF WORK <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 F•ood <br />Exhaut.tfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />OUrer <br />CITY OF EVERETT LOCAL SALES TA% CODE IS �105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisfons of laws and <br />ordinaces goveming Ihis type of work will be complied wilh whether specified herein or not. The granling of a permit does not presume <br />to give aulhority to violate or cancel the provision of any other state or local law repulaling construction or the perfortnance of <br />conslruction. Thal I am auth,�rized by the owner oi this property to perfortn the work fur which applicaGon Is made and I comply with the <br />Sta� Cont�actors Law�8.27 RCVV and 296200 WAC. �/ /� <br />�, �v "y% <br />� <br />