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PtRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-d857 — www.everettwa.org <br />APPLICATIONS ARE At:CEPTED FROM 8 AM TO 4 PM j Q ... �'Z_.�� <br />SITE ADDRESS PARCEL TAX I.D, i1 PE IT # <br />.3�0� cv�,��u.F:<.���o �,��i�d F�fi,i9 9 03 �/0 -C:�J3 <br />LEGAL LUTNO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS CITYIZIP PHONE <br />,3ap� u���r �v�,�e=rT ��i 3d <br />`Ibff til �j L-"r�m �9- 5T/�C�y r��ukic r�-a .8/_�i� tc��� 9yan•� <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE il <br />USE Of B//U�ILDING/J ,/ • <br />�j(.�77�jn� �'Y�'�CC)%'/I��/y <br />�tCCn6� Y�dC•- - ��li <br />WORK DESCRiPTION <br />i�„�,.� f� <br />./ c.�_ »i-�� ✓,(� I t�. t. <br />l <br />.,� ,,..�,.� <br />CONTACT FOR PERMIT <br />ADDRESS <br />HEAT SOURCE <br />_ Eleclric �Gas _ Olher <br />O fzc. ticti 1�c <br />c� <br />NO. I NPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Waler heater <br />Sink (service/badmop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />CITYIZIP PHONE <br />CONTRACT PRICE OF WORK <br />C�2 0l�-� / 7� %�• �-i � lc' NZ'�-ne <br />�r,�,,�t ��i,�i.� -LL�t.�Y�-,._�• <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />Forced air systems <br />Gas pipinc� <br />W ater heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />,�.-,.. �. <br />I hereby ceritify Ihat I have read and examined ihis applicalion and Anow the same to be true and correcl Ail provisions of laws and <br />ordinaces goveminc� this rype o( work will be complied with whether specified herein or nol The granting o( a permit does not presume <br />to give authorily to violale or cancel the provision o( any olher state or local law regulating construction or the performance of <br />construclion. That I am aulhorized by �he owner ot this property to perform the work for which application is made and I comply wilh the <br />Slate Contractors Law 18.27 RCW and 29G.200 WAC. <br />�7„-, �,-v n.o �7`� a, ,. /Z)�>��dG, <br />