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( <br />P�RMIT 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 8 AM TO 4 PM <br />SITE ADDRESS <br />J�', p�- l,i � i OJc� F1 t( f <br />DESCL LOT NO. � BLOCK <br />;O&5� S� �-f4S <br />TRACT <br />PARCEL TAX I.D. # <br />n <br />f If <br />09- <br />�� z v�, �R <br />` /�r.��, i<<�C :�3oc wt�l�o�GM-cc. ��s RR�� �-o�-`f�r8-o3 »' <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />—�� vRN� a-��-Y53-o3�g <br />�^NTRACTOR ADDRESS CITY2IP PHONE <br />7 <br />CONTR. LICENSE p % �'� <br />v' �K'`'/' _, <br />USE OF BUILDING <br />I' � Il;)1'rJ�.Fr <br />HEAT SOURCE <br />_ Electric � Gas _ Other <br />WORK DESCRIPTION �� �� tiZT ' V?���.�,�-, <br />ft UV ��'i�I l IT Ic�iV GL'}-r.J!'t 7.' L�(/fN(� <br />�✓!'u r/n�,t, t f p�/(YI q✓1 ! Y�. <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Wa1er heater <br />Sink (serviceNar/mop/elc.) <br />Back(low prevenler <br />Urinal <br />Drin{,iny Founlain <br />Floor drain <br />C rease trap <br />Roof drains <br />Olher <br />� <br />CONTRACT PRICE OF WORK <br />� 35��, � <br />� nr-o E� � r�' „' �, �-. � c c� es E�-�-- <br />�2.0,�+^.. F. 0}^< r, Y�-R.E�? 7b LYLC-':9'it" Nl� <br />NO. I TVPE OF FIXTURE OR ITEM <br />� <br />/v'C — air handling unils <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas ranga <br />Cbthes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unil healer <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />i hereby ceritify that I have read and examined this application and know the same to be true and correcL Ali provisions ot laws and <br />ordinaces governinc� lhis type o( work will bo complied with whelher speci(ied herein or not. The granling of a permit does not presume <br />to give authority lo violate or cancel the provision ol any olher slate or local law ragulaling consWclion or lhe performance of <br />consiruclion. Thal I am aulhonzed by Ihe owner of this property to periorm the work for which applicalion is made and i comply wilh the <br />Slate Conlraclors Law 1f}yZ7_ t� and 296.200 WAC. <br />� ' __�\-� :Y�-�i/ <br />` /% � " �' �, <br />