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�'ERMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, W.4 98201 <br />425-257-881 � - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />��:-{,�, j��..,� �� <br />LEGAL LOT N0. BLOCK <br />oEs�. � "L <br />OWNER <br />r ''7 <br />�1�1'�_„ -� %� L i.»�.�cr�1�n�� <br />TENANTNAME <br />PARCEL TAX I.D. il <br />�`� 3`� - Go2 -CC i - <br />TRACT OR SUBDIVISION N <br />ADURESS CITY/ZIP PHOIVE <br />IT # <br />UU <br />� '� �C�. �j '.�i`.� _1CL.•_ <br />-,�'� .xr, AJ�- C e,-C OLC <br />CONTACT FOR PERMIT PHONE <br />� j,�� % � E•MAIL <br />�dNT A AD RES CI /ZIP ���- <br />•- <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEATSOURCE <br />_ Eleclric _ Gas <br />Other <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTIO� � ) / <br />,--� / C �I -x x•, ` �� IcCc��+�evlT <br />, <br />1': c ., � c ,. � :, � �,-!� � �; �� _,�, „�� ,—m����e, r � `7 <br />LL71,L <br />IiO. I TYP[ OF FIXTURE OR ITF.M <br />T� <br />6alhlub <br />Lzvalory (wash basin) <br />Shower <br />Kilr.iian sink & dispcsal <br />Disiiwasher <br />Clothes washer <br />Waler healer <br />Sink (service/bar/mop/e�c.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grea;e lrap <br />Rool dreins <br />Other <br />NO. I NPE OF I�IXTURE OR ITEM <br />A/C - air handlinc� unifs <br />Foiced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />[xhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Relrigeration <br />Woods�ove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />I hereby ceri�ify that I have read and examined lhis applicalion and know Ihe sarne to be lrue and correcf. All provisions ot laws and <br />ordinaces c�overning this type o( work will be complied with whether specified herein or nol The granling o( a permit does nol presume <br />lo give aulhorily to violale or cancel ihe provision e( any olher state or local law regulating conslruclion or the performanca o( <br />construclion. That I am aulhorized 6y Ihe owner o( this property lo perform lhe work for v+hich application is made and I comply with thr. <br />Slate Conlrar,tors Law 18.27 RCW and 296.200 WAC. <br />,•L, � ) „ �. <br />