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PRMIT APPLICATIAN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - vmv.everettwa.org <br />APPLICATIONS ARE ACCEPTED FRIN 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT N <br />�_ z. s ?�Ilv Gr- lVsoo ±22 0? 7r)q 11-ozy <br />LEGAL LOT NO. /y�B_L�O.7CK/y� TRACT OR SU1B'DIVISIONN�N '-}� <br />DESC� _ L '� �J WT Y �W �UI�L�f� Y� IV• I r 7 1 <br />OWNER ADDRESS CITYIZIP PHONE <br />N e s f' g�� <br />TENANT NAME CONTACT FOR PERMIT PHONE 2-57-7 - <br />I E-rdAIL <br />CONTRACTOR N( ADDRESS CITYIZIP PHONE <br />w <br />CONTR. LICENSE N <br />USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br />SiNaf/f FnN.ly rfS, Electric _Gas _Other <br />WORK DESCRIPTION � u j lG e (2 LlH'qi 1/e k, .� 7i 57bY<jr kN lOVC7-Fs•I <br />FGf) <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (service/bar/mopletc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I 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 />_ Clothes dryer <br />_ Range hood <br />_ Exhaust fan <br />_ Heal pump <br />_ Unit heater <br />_ Boiler <br />_ Refrigeration <br />_ Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 0105 <br />hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />l0 give authority to violate or cancel the provision of any other slate or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />