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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVER[TT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — ww�v.everettwa.org <br />AFPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOl" ACCEPTED <br />SITF'. ADDRESS a��t7 PARCEL TAX I.D. # I P�RMI� i <br />I�1 �O�'� M�E ��fl' uVA� Zq d5�o°) G�03 D�) DO o--d; � <br />LBOAL� LOTNO. � BLOC TRACT <br />�,�.,<,r ���rvt��l��ari_ <br />1��'r►.A�'�s 1,Ai1i� A.1�4 U.G l�'1 I t2o� p.� �r � I/V6 � P, 20 � 22'1-ri' <br />TENANT Nnm� CONTACT FOR PERMIT PHONE <br />4�-r �� 1M►�Et-�� I �� �f'oKE�s (A�) �58 - I °) io <br />CONTRACTOR � � ���1fI `� qDURESS CITY2IP PHONE <br />� � fT�r� jv1 <br />CONTR. LICENSE # <br />USE OF BUILDING <br />W�V2� <br />WORK DESCRIPTION <br />�1 <br />HEATSOURCE <br />Electric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />� l��i� oao . o0 <br />1�=�W Wl�t-�� �A� w� 11.�G+-�a'�ll�r' ��o '`� 5� <br />►�a� -�'A.u- MD�Ot'ol.� <br />NO. � TYPE OF FIXTURE OR ITEM <br />I oi�e[ <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink R disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roo� drains <br />Other <br />NO. � TYPE OF FIXTURE OR ITEM <br />s� Evc — av hantlhng unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireolace <br />Gasrange <br />Clothes dryer <br />Range heod <br />Ezhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />� Olher_��� ��`j <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceri�ify lhal I have read and examined this application and know the same to be hue and correct. All provisions of laws and <br />ordinaces governirg this type of work �vill be complied with whether specifed herein or noL The granling of a permit does not presume <br />to give authority to violate or cancel ihe provision of any other slate or local law regulating construction or the pedormance of <br />constructioa That I am authorized by the owner of lhis property to pc�form the work for which appliwtion is made and I comply with the <br />State Contr c rs La 1827 F�W r d 96200 WAC. <br />�/. 1 <br />Signatur of wnedConiractodA tl nze gent Date 1� <br />