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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 />SITE ADDRESS % d'�� -= 111- /�'lU<� lL i EC PARCEL TAX I.D. # <br />��vD�. o�.�� lvA��i',"�,_� �`iL�43�GO ��-���,c <br />LEGAL lOTNO. BLOCK TRAC(� <br />DESC. �� fGIG1�L��i . <br />OWNER ADDRE55 � <br />�3s�a s�,��,�,��= i� ��r-, <br />tC'GWn�t`,-,CATH K;LEj/>c�i✓,v�E tvn �9 <br />TENANTNAME <br />CONTACT FOR PERMIT <br />I<'�[r Lcctla%����3%N <br />CONTRACTOR ADDRESS <br />,���VASZ�� C�`�;ST,EUci/c.ti% Z���ZJ,vt-� <br />CONTR.UCENSEp � >: <br />ti�/VASC �f"I� � �(,' � ,�c.A.�l��iJQ <br />USE OF BUILDING <br />s r'�C <br />WORK DESCRIPTION <br />�'GI�� i�('l'St- <br />NO. I TYPE OF FIXTURE OR ITEM <br />� Toilel /'� <br />� Balhtub � �� <br />� Lavatory (wash basin) J`i <br />� Shower <br />L Kilchen sink & disposal <br />J Dishwasher <br />1_ Clolhes washer <br />� Laundry tray <br />Sink (service/bar/mop/etc.) <br />_ Backllow prevenler <br />Urinal <br />Orinking Fountain � <br />Floor drain t <br />Grease trap <br />RooF drains <br />Olher <br />RMIT # <br />� -OI � <br />�HONE <br />zs-�.3; � - � c�is- <br />ZCI al'Y" �� �;�' <br />>HONE <br />�;'��- yG/ S <br />5 ,-! ._ z , ., ,� <br />l.i, CITY2IP � � PHONE <br />>�'�si. (��5) 5�'d-E6�'i <br />,I✓A `i4'c S� ��f�s) yl�'—i4�2� <br />HEAT SOURCE � CONTRACT PRICE OF WORK <br />_ Electric � Gas _ Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />/ Forced air systems <br />�= Gas piping <br />i Waten c�ater <br />� Gas fireplace <br />/ Gas range <br />! Clothes dryer <br />i Range hood <br />j_ Exhaustfan <br />Heat pump <br />Unil healer <br />_ Boiler � <br />Refrigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify Ihat I have read and examinad lhis applicalion and know ihe same to be true and correct. All provisions of laws and <br />ordinaces goveming lhis lype o( work �vill be comptied wilh whether specified herein or noL The granting of a permil does nol presume <br />lo c�ive authorily lo violate or cancel lhe provision of any olher state or local law regulaling consiruclion or the per(ormance of <br />construction. That I am aulhorized by lhe owner of this property to pedorm the work (or which application is made and I comply with Ihe <br />State Contraclors Law 1827 RCW and 296200 WAC. -� <br />/ �/�. � /� J �. <br />/��) /'_�.'It1Ll�.iLsj.ql/� _ �/ / . _ <br />