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P�RMIT APPLICATIO�V <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 PARCEL TAl( I.D. # <br />S�"iIq RUC�CFEL�CR ooy�sg�o�oo�oo <br />LEGAL LOTNO. BLOCK TRACT <br />DESC. � p0� �.AUQE.c.. N E�(�HTS <br />OWNER ADDRESS CITY2IP <br />N�r�.� C3�us. 3qaa B�+�Da��. N,E E�EaE-�-ragaos <br />TENANTNAME <br />CONTRACTOR <br />F{�1�C,K (3�05, COIVST <br />CONTR. LICENSE k <br />USE OF BUILDING <br />Sr� <br />WORK DESCRIPTION <br />PERMIT # <br />9�•7360 <br />CONTACT FOR PERMIT PHONE <br />�oE� Nww�k wzs-a�o-ay2q <br />ADDRESS CITY2IP PHONE <br />3�aa g��q�E• N,� �EaE�r-r yz.S 3q�-�3eo <br />q8dos <br />HEATSOURCE <br />Eleciric _ Gas _ Olher <br />DE,�o. <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilat <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposa! <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (servicelbadmop/elc.) <br />Back(low prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Other <br />CONTRACT PRICE OF WORK <br />5K <br />NO. � TYPE OF FIXTURE OR ITEM <br />�VC — air handling units <br />Forced air systems <br />Gas pipinc� <br />Water healcr <br />Gas fireplace <br />Gas ranc�e <br />Clolhes drycr <br />Range hood <br />Exhausl (an <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerili(y lhat I have read and examined this applicalion and know the same lo be lrue and correcL All provisions o( laws and <br />ordinaces goveming lhis type of �vork will be complied wilh whelher speci(ied heroin or noL The grantinc� of a permit does nol prosume <br />lo c�ive aulhoriry to violate or cancel lhc provision of any olher slale or local law rec�ulalinc� construction or the performance oi <br />const�clion. T►�,3t I am aulhorized�y jHe'owner of lhis property lo perform lhe work for which applicalion is made and I comply with lhe <br />Slate �t�clok� Lav+ 1�.27 RCW r{d 296.200 WAC. <br />