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PCRMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - Hv✓w.everettwa.org <br />APPLICATiONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />ZO l li W� } 11, �e � c lJ <br />' �(�� vo <br />LEGAL LO�NO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS CITYlZIP PHONE �G <br />��� Fra �L«u� i� 3� �� �� ��� Jf. s«,�,� G-9 5'd�� ��� i.r�� <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />� Kl�c �si 4oi 2� 6- 3� I-/ S- 2�1 <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />CONTR. LICENSE lt <br />U j -�� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />HEAT SOURCE <br />fy Eleclric _ Gas _ Other <br />InP r..i CC9�-. J�4^ �C N(9r. . <br />,' <br />�r <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />W aler heater <br />Sink (service/badmop/cic.) <br />Backtlow prevenler <br />Urinal <br />Drinking Founlain <br />F�oor drain <br />Grease trap <br />Roo( drains <br />Other <br />CONTRACT PRICE OF WORK <br />N0. 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 freUlace <br />Gas range <br />� Clothes dryer <br />�Rangc houd <br />'Exhausl (an <br />Heat pump <br />Unit healer <br />Boiler <br />Re(ri�eration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this application and know ihe same to be lrue and correcL All provisions o( laws aud <br />ordinaces goveming this type o( work will be wmplied with whether specified herein or not. �he granting of a permil does nol pre;ume <br />to give aulhonly� violate or can-el lhe provision of any olher state or local law regulaling conslruclion or Uie performance of <br />conslruction. 7 3.t I m authoriz by the owner o( lhis property lo periorm the work for which application is made and I comply wilh the <br />Stale ConVagt�r��I�.27 R�N' and 296.200 WAC. <br />(, - Zo - ��� <br />