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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, lNA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 0 AM TO 4 PM 3� Q�� <br />', C� � . SL �� .�� ' i <br />LEGAL LOT N0. BLOCK <br />DESC. <br />OWNER <br />���+'L-• �f �f��-S <br />iENA NAME <br />f� n � i9,�<� �� , � :� � +� <br />.ONT ACTOR <br />-rNc i<<�� Fr�-1�,.•� <br />"ONTR LICENSE it <br />—����?�',F� [> � v 1 I <br />USE OF UILDING <br />PARCEL TAX I.D. k PERMIT p <br />�So O� o/,� OG2!% 2 I�//b Z' <br />TRACT <br />5,,,1�1 cY S Sc�cx��1�>i i�i l/L P/�-� il �vc, ��� <br />CONTACT FOR PERMIT J�� y,� 1��,� pHONE <br />�ti-�� /%�i��: i U2, r��:Lz �zv c% <br />ADDRESS <br />� <br />��� _ TYIZIP /J PHONE ' <br />cj'/5._,� ��— lT�✓�%Lrvw�/ [y9. G/'2-y ci�1-2 /'� =`'� <br />Q J't�73 <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />WORK OESCR�i'TION � <br />�ir-N 57�a � c � n,'� ,,� - T� c_ v;�,,� r t,t n-� <br />i rq ��1 c�i--' f.�,. .,� Et_� �, . <br />NO. I TYPE OF FIXTURE OR ITEM <br />�onet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc J <br />Batkflow preventer <br />Urinal <br />Drinking fountain <br />Flcor drain <br />Grease lrap <br />Roof drains <br />Other <br />� r� v <br />cc-�t LL <br />NO. � TYpE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Gothe=_ dryer <br />Range iiood <br />Ezhaust fan <br />He3l p�mp <br />Un,t heater <br />Bo3er <br />_ Re(rigera6on <br />Woodstave <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby ceriti�y that I have read and examined �his application and know the same ,o be irue and correct. All provisions of laws and <br />ordmaces goveming this type of work will be complied with whether specified herein or not. The granting of a pertnit does noi presume <br />to give auihority to violate or cancel the provision cf any other slate or local law regulating construction or the performance of <br />construction. That I am aulhorized by the owner oF this property ro perform the work for which applicatian is made and I comply with Ihe <br />Stat� Contractors L• .v/ �1�27 RCW and 296200 WAC. <br />� � ,�' ���� �' (�� �1,�'�i- <� � � �� 1 / <br />�IZ <br />