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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.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />�, ,. �-����•� <br />LEGAL LOT NO. BLOCK <br />DESC. ,_ . � ! / /." � � <br />OWNER <br />.. . . . .., i' . . . 'r, r �- S <br />TENANTNAME <br />CONTRACTOR <br />I�, ,i..'� . .. .. �i. .... �i _. ,.._ ..... , <br />CONTR. LICENSE N - .� ,5 � .� <br />... ;l.l.', +�'-'i <br />USE OF BUILDING <br />i ,�,�,,,�., iir��.�4_,� <br />WORK DESCRIPTION <br />2t�l��r�.�� L�.��:� <br />PARCEL TAX I.D. It <br />� r� ;�,�>,y_;;� _ <br />TRACT <br />�7�-fi:_r� �-:C,e�r�;.. <br />:-r.,i'�.. ,'���'%'� <br />, G' <br />CONTACT FOR PERMIT <br />;. i ��i l)0.uvr�n:�� <br />AODRESS CITY2IP <br />,�lrr .�:_ . ��. .r.'., <br />� . � <br />HEATSOURCE <br />'-_ Electnc _ Gas _ Olher <br />i ��0.���'.r� '_ /i�l'a,J ��LCG�/LBG�L <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Ba1hWb <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backtlow preveNer <br />Urinal <br />Drinking Foimlain <br />Floor drain <br />Grease Irep <br />Rool drains <br />Olher <br />PERIdI�T # <br />'� — <br />, _- <br />PHONE <br />� �-_ ] ' . �� . , . <br />PHONE <br />�.'�i`il� ���1 <br />PHONE <br />.�:� , , . . _ . � . <br />CONTRACT PRICE OF WORK <br />,. ,. <br />r. <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C – air handling units <br />Forcetl air systems <br />Gas piping <br />Water healer <br />Gas 6replace <br />Gas range <br />Clolhes dryer <br />Rang� hood <br />Exhauslfan <br />Heal pump <br />Unil he2�er <br />Boiler <br />Refrigeralion <br />Woodslove <br />Olher <br />CITV OF EVERE i T LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify Ihat I have read and examined ihis applicalion and know Ihe same lo Ue true and correcl. All provisions of laws and <br />ordinaces governing this �ype of work vnll be complied wiQi whelher specified herein or nol. The granting of a permil does not presume <br />to give aulhonty to violale or cancel ihe provision o( any olher stale or local law regulating construction or Ihe performance of <br />conslruction. Thal I am authorizeA by the owner of Ihis property lo perform the work for which application is made and I comply wilh the <br />Slate ConlraGlors Law 1D27 RCW and 296200 WAC. <br />. �'y /' � -� q� o�� <br />1'. �/1L��i>ial_ � <br />�' <br />