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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 />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />SITE ADDRESS g� O:�y%/I/4 N�� PARCEL TAX I.D. A PERMIT N <br />,EY�.CErr' n��l 98.Zo� I o0�6�r7o 0 00� �+oo I ,(�j 7C� �' Lo�% <br />LEGA LOT NO. BLOCK I TRACT OR SUBDIVISION N <br />oesc. SLr. oo-D-oo �/�i4�do�t' d/Et✓ <br />OWNER� � OhI{� /� nv�nc�%I�//%C ��Jf�{�D � / /S/�'��G'� <br />� �S�J �'' �.,?S-.z'r$'�i�I <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />r�wnil'.P. ,P. -✓. o�.i►/�� �zs-za �-� 989 <br />CONTRACTOR <br />o�✓rv�'�2 <br />CONTR. LICENSE p <br />ADDRESS <br />$�'2� OL �/�r�iC �$�l�ti <br />CITY2IP PHONE <br />/_= vr�'� /T �s -7 J3-/989 <br />elSZ o3 <br />USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br />�/�R� .�j E _ Electric _ Gas _ Other ��) ���� 2�� � <br />WORK DESCRIPTION <br />5i�1��./_- D�_T.�crfr� GA�rJGE <br />q'-c��� � 2��_�„ <br />NO. � TYPE OF FIXTURE �R ITEM <br />Toilet <br />Bat�tub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />8ack0ow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Root drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhausttan <br />Heal pump <br />Unit heater <br />Boiler <br />Rofrigeralion <br />Woodstove <br />Jther _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined this application and know lhe same to be true and coRecl. All provisions of laws and <br />ordinaces governiny this type ot work will be complied with whether specified herein or not. The granting of a pertnil does nol presume <br />to give authoriry to violate or cancel tho provision o( any other state er local law regulating construction or lhe pedortnance of <br />conslruction. That I am aulhorized by the owner of ihis property to per�orm the work for which application is made and I comply with the <br />Stale Contractpr�s,Law 18.2�RCW and 296.200 WAC. � <br />� �� � _ ,� 5��:-a7 <br />