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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 -1=AX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />G ( �b�t,4a� tZr� E�/E�.E7� <br />LEGA LOTNO. BLOCK <br />DESC. 2(+ .�r �(� <br />OWNER <br />�pLPff ��.JLa�b�.�,,� <br />TENANTNAME <br />PARCEL TAX I.D. # <br />�34 a000 2�Fao <br />TRACT <br />t�EVE�(c.�C ffr�Ls 1�iJ. <br />ADDRESS <br />uovsGtus �o.,�rryoy w� <br />CONTACTF RPERMIT <br />� �'�L2�{ 12oae✓L C 3Go� (008 - �843$ <br />CONTRACTOR "�8a ADDRESS CITY2IP PMONE <br />CONTR. LICENSE N <br />USE OF BUILDING ��h. <br />HEATSOURCE <br />_ Eleclric _ Gas _ pther <br />3 - �� <br />CONTRACT PRICE OF WORK <br />� 1 S� d00 .00 <br />WORK DESCRIPTION ( NT'rd(.d'7�ON G� AfJT'E�A/A1 d SyK'rE�n+ oN �7C(3'rtNC� <br />U�L It4 � . <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BalhNb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />BackAow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drdins <br />_ Other <br />N0. � 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 hood <br />Exhaustfan <br />Heatpump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />� hereby corilify that I havo read and expmined this eppiicntion and know the seme to be true and correct. All provis(ons of lews end <br />ordinaces overning this ty will be complied with whether specified herein or not. The granting of a pertnit does not presume <br />to ive autho i to violale o cancet the ovision of an other state or local taw regutating construction or the peKormance of <br />9 ,J �ry Y <br />construa�On. hat I am auth 'zed by th� owner of this property to perfortn the work for which application is made and 1 compiy with the <br />State Cohtra ors Law 18.27 W ar�d'296.200 WAC. <br />t <br />1z <br />