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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.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />tESS� PARCEL TAX I.D. N PERMIT # <br />>.��.�� /5��, UoSs� y�,o �o �l �/�o .�„�-, <br />LOTNO. BLOCK ,�,RACT � � � <br />/�i �n /11,Ii71'/IU_./-/T�C'/C�� ��/L�/S/dN `� <br />�����i Sv,.� L0%�i�a, /7yU� NC �/S��S�; # /� ��<��f,»�,rc; r�- �c� i� 3 �v4 <br />TENA'.�T NAME CONTACT FOR PERMIT, PHONE <br />lD/k�cL�'1�ATTISouI a��,-�,3-���0 <br />CO TRA TOR„ �,� ✓I�IJa�.`���DRESS . CIN21P PHONE <br />4�-f,1�.�r/x���� �« �v,:h'c�x G�3C-S' Lc�i�.���a���/ ��G�-��s-�y��v <br />COhTR. LICENSE , � <br />�-c fa� � � � 53 �T- G �I �a� �> <br />USE OF BUILDING <br />S�2 <br />WORK DESCRIPTION <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/barlmopletc.) <br />BackOow preventer <br />Unnal <br />Dnnking Fountain <br />Floor drein <br />Grease trap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ Eledric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />Forced air systems <br />Gas piping <br />1Nater heater <br />Gas fireplace <br />Gas renge <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EYERETT LOCAL $ALES TA% CODE �S �106 <br />I hereby centify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of vrork will be complied wilh whether specified herein or not. The granting oi a pertnit does not presume <br />to give authority to violate or cancel the provision o( any other state or local law regulating construdion or the perfortnance of <br />construction. That I am authorized by the owner of this property to perfortn the work for which application is made and I comply with the <br />State G6ntractors Law'1827 RCW and 296.200 WAC. <br />/Y 'i'.'�t'i �� �%-ffiSi._ <br />