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P�.RMIT APPLICATI(.�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETi', WA 98201 <br />425-257-8810 — FAX 425-257-8857 — �,vww.everettwa.org <br />APPLICATIONS ARE ACCEPTE� FROM 8 AM TO 4 PM - DEBIT S CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />`liKl y�u <br />LEGAL LOT NO. <br />DESC. � <br />OW NER <br />1,.41�e f.ib, D <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />l3LOCK <br />({u�-...=5 �JviC. <br />PARCEL TAX I.D. # PERMIT # <br />z�oyi3-ooz-o��l-ac �r � <br />TRACT .$VF �1(., "�0`iB1S SP SEG-?�u�/ �3 �o�..SH�P Z5 h/ <br />:c�xnin unacc 97oC,o55w4 �rMsc 4 �-hti <br />ADDRESS CITYIZIP PHONE <br />Po. �3cx 8�1� �e. S�cvwl S—`�s8 <br />CONTACT FOR PERMIi pHONE <br />S ic_lJc v�m2p�,S •�z�- 35G.. 7"IG "1 <br />L-AeG�✓��+D 1C$ ADDRESS <br />I-iv n T� c - <br />USE OF BUILDING <br />LAK�L��.I' pp� J� <br />WORK DESCRIPTION <br />L/l. 19� V � r �'`'- <br />N0. I IYI�E OF FIXTURE OR ITEM <br />Toilel <br />BalhWb <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry iray <br />S�nk (service/barlmop/elc.) <br />Back�low preventor <br />Urinal <br />Drinkinc� Founlain <br />� Floor drain <br />Grease lrap <br />Roo( drains <br />Other <br />CITY2IP PHONE <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Eleclric Gas Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water hoater <br />Gas fireplace <br />Gas range <br />Clolhes dryor <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CIN OF EVERETf LOCAL SALES TA7( CODE IS 7105 <br />I hereby cerilify ihat � have read and examined this applicalion and know the same b he lrue and correct. All provisicns of laws and <br />ordinaces governing this typa of work will be complied with whether specified herein er noL The granting of a permit does not presume <br />to give aulhonry in vioiate or cancel Uie provision ol any elher stale or local law rec�ulaling construction or Ihe performance o( <br />conslruction. That I am aulhorized �y the owner of this property lo pertorm the work for which application is made and I comply with the <br />Stale Conlractors Law 18.27 RCW and 296 200 WAC. <br />�- �_--_�-,�.-� . 8/s/� s <br />