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PERMIT APP�ICATION <br />CITY OF EVERETT PERMIT SERVICES <br />320U CEDAR STRE[T, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS . _ , . : � ' <br />Jti � <br />LEGAI LOT NO. : � BLOCK <br />DESC. � -��`+ � � � <br />_ � / � _iL — <br />OWNER <br />— � ( �� ` <br />TENANTNAME <br />L - _, <br />CONTRACTOR <br />CONTR. UCENSE N � � � . <br />USE OF BUILDING <br />-. , ' � ,, i t .'1 �� �.: <br />WORK DESCRIPTION /C � ,V; 5�-; �.1-n✓`�' '�"u '^' ��� � <br />,�`�o%..-..J� ,�.:�.;:•. � � � c,✓ '../: (� i .?� NtW <br />� <br />PARCEL TAX I.D. ll <br />„t`�_i � 5 `�C',jG•���' " �'����- <br />, ^ .-- / �� hIL'/�� .0 <br />r �� <br />ADORESS � <br />, %'� � ' S �� : /.�� �v � <br />I CONTACT FOR PERMR . <br />� <br />�` • t � - �. �' <br />_ ,� � � <br />nooRess cinm <br />I — HEATSOURCE <br />Electnc �' Gas _ Other <br />Jc.� � •� ;i '\ j, i <br />PHONE <br />�-'c � `!� � - �Ci.� ` <br />P PHONE <br />CONTRACT PRICE OF WORK <br />�� ,. – <br />C. /JC/'Ii.CtYLi-. � 2' /�X?,� <br />�C.i(/�Lh . ��.J�.✓t/���o��'. <br />� �i,"'iil /�:'.'i'�i /:'.v i i / � �j�o ,,; J .L`�•,;' , iJ�?� i J � / <br />PLUMBING ', T' .�4 h=" �-` ,1-.-�•� • <br />NO. I TYPE OF FI%TURE OR ITEM :_� r���' �l` `� �` N0. I <br />Toilet <br />8athtub <br />Levatory (wash Dasin) <br />Shower <br />Ktichen sink 8 tlisposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (servicelherlmopletc.) <br />Backflow preventer <br />Unnal <br />Dnnking Fountain <br />Floor drain <br />Grease Irap <br />Roof drains <br />Other <br />CO-. .%.'ui � J–�/ Y�G' iJ«�: i <br />TYPE OF FI%TURE OR ITEM <br />A/C – air hantlling units <br />Forced air systems <br />Gas plping <br />� Water healer <br />Gas Greplace <br />Gos range <br />�i: Clothes arycr <br />' t� Ran9ehood <br />� Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Relrigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby cenlify lhat I have mad and examined Ihis appiicalion and know the same lo be We and corred. All provisions of laws and <br />oidinaces goveming this type of work will be complied wiih whether specified herein or not. 7he graming of a permit Aoes nol presume <br />lo give authonty to violate or cancel lhe provision of any other state or local law regulating wnsWction or lhe pertonnance of <br />construclion. Thet I am authonzed by ihe owner of Ihis property to peAorm ihe work for which applicalion is made and I compry with Ihe <br />State Contractors Law 1827 RCW and 296100 WAC. <br />J. =- --- 0)-03-0.4� <br />Signature of Owner/Conlraaor/Authoiizetl Agenl Dete ��L <br />