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( <br />� <br />PERMIT APPLICATION <br />CITY OF EVEREiT 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 - DE81T & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS � <br />Li5 V.. �aJ; <br />LEGAL LOT NO. BI�O"CK <br />DESC. /� �J�U/ I, <br />u"t` t y^1 <br />I� e..�� � `-`�1✓�� <br />TENANT NAME <br />�4v'��-1�.. J <br />CONTRACTOR I.�� <br />CONTR. LICENSE # <br />PARCEL TAX I.D. # <br />D o�}4�0 3 a o�c o � So 3 <br />TRACT ��r.i �.�-� Jl��' 1 i-`1�1 �} c 1>>k.� <br />F �.L LJSD �2oi- 10 �1 •. -. . . . <br />1 �U,'T�'!�SU•� <br />CONTACT FOR PERMIT <br />M.�+t Nt4 _+�� <br />PERMIT # <br />i� 0 1 (, ci � � <br />�� CITY2IP PHONE 3 bc. �'Ip�_ t <br />.3) Z t- �c�c^-� ; � �=iSS'�.� G <br />�C �' ��ta- PHONE �-r..- <br />f:vbCf <br />L`1 <br />�+'+---a► � i <br />f�C�����L�, A�DRESS\4'�\D �p(Sr CITYIZIP PHONEB��_S�,i_ <br />� y <br />�}���1G �3 � _ u�t� <br />USE OF BUILDING HEAT SOURCE l:U1V I KA <br />� S �' `� C �� _ Electnc �G� a ' Olher � y <br />WORK DESCRIPTION <br />�—�— `_ _ <br />c�^ ` ` <br />(�c�J�ce�t. G'.I '�.i; �GIL' �� v%. �\�.c�-i't.� w�.`1�\ S'ct r Js:"tj _ <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lava�ory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar7moplrtc.) <br />Back(low preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />PRICE OF WORK <br />N0, I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby centi(y �hal I have read and examined this application and know the same to be true and wrrect. All provisions o( laws and <br />ordinaces governing lhis type of work will be complied wilh whether specified herein or not The grenling of a pertnit does nol presume <br />lo give authonty to violate or cancel Ihe provision of any other state or local law regulating construction or the pedormance of <br />construclion. That I am aulh Rnzed y the owner of this property ro pedorm the work for which application is made and I comply with the <br />State Cdri[aclors LpFv 182'{ RC�a{{d 296.�00 WAC. y � <br />