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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425•257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4?M <br />SITE ADDRESS <br />�}2Z S�H�sT—k� <br />PARCEL TAX l.D. # <br />5fJ5�opOf7 I> DZo2 <br />LOT NO. I BLOCK I TRACT OR SUBDIVIS17N N <br />—ac � <br />IT# i <br />L%- (� <br />OWNER ADDR�SS CITV2IP PHONE ',3'�O� ��� <br />fiNDREVJ � usA COUGE{Lr►� 9`E22 �4ti1UP�T�QVEr ��I", wf� Qg201 <br />TENANTNAME C\ONTACTFO� PERMIT PHONE / <br />•"/(1 JI �� ,� l� i'r�� il �E-MAIL�J , D�o /c / <br />J <br />CO C O d S 21 <br />�l CL,�,� 7lr�C.a ; ot_ <br />CONTR. LICCNSE p � � <br />_ �wS" <br />USE OF BUILDING HEAT SOURCE � CONTRACT PRICE OF WORK <br />Cr� — � p �� <br />_.,�— �--, lEleclric Gas _ Other � � I f 3 9 Z�� <br />WORK DESCRIPTION <br />� S 3 s, �, ac� �nbN �� r��. � n.��trrz- �� ec�n� <br />NO. I TVPE OF FI%TURE OR ITEM <br />�— <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Ki�chen sink & disposal <br />Dishwasher <br />Clothes washcr <br />Waler hea�er <br />Sink (servic�ibai/mopletc.) <br />Backllqw preventer <br />Urinal <br />Drinking Fountain <br />Roor drain <br />Gc asc Irap <br />Roof dreins <br />Olher _ <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />AiC — air handGng units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas lireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Eahausifan <br />Heat pump <br />Unit healer <br />Boiler <br />Retrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />I hereby centily that I have read and ezamined this application and knoH� ihe same to be true and correcl. All prowsions of laws and <br />ordinaces governing ihis type o� work will be complied wilh whether specdied herein or noL The grantinr� of a permil does not presume <br />to give authorlty to violale or cancel the provision ot any other state or bcal law regulating constmclion or the pertormance of <br />construction. lha� I am aulhorized by the owner ol ihis properry to pertorm the work lor which applica�ion is made and I comply with the <br />State COniractOrs Law 7827 RCW and 29G.200 WAC. <br />e of OwnevContractorl uthonrntl �gent � ua�e �- <br />t%��l'lf�S' hJi�.� . c= � �` <br />