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. , <br />` I i '� �� ' <br />SITE ADDRESS <br />_�,7� � � <br />LEG LOT NO. <br />DESC. <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />�y � Y� � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. • <br />.� <br />'- �z---fl c-r. L E�� � `/ I ? � �C f `J L � <br />BL�� iRACT <br />�i�a--d6 <br />G� / !��✓'� U <br />�� iA��i 1"��,�r• i� L�y�l,tc�( �.b�� ��d( i:' .� .-�ot Cb7�C(i'L <br />TENANT NAME I CONTACT FOR PERMIT <br />':�1,.;� i �,i� <br />��1. � <br />CONTRACTOR Cj� �� �- 5% c��� I S ADDRESS ._,y CITYILP <br />% '1t. 1 l.t l.'i �v`i�i�li/�� <br />CONTR.LICENSE/ �i i .� <br />�- u , >'1 r ��-',,;�; <, ��� ,7 <br />USE OF BUILDING <br />� <br />r r: �� <br />WORK DESCRIPTION <br />NG. I TYPE OF FI%TURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clott.es washer <br />Laundry iray <br />�ink (servicelbarlmopletc.) <br />BackBow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />PHONE <br />� L CSt `/ <br />PHONE <br />C�Zh yCz C�,�`% <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Elednc � Gas _ OL �er � � -� %C/ �' <br />N0. TYPE OF FIXTURE OR ITEM <br />2 AIC – alr handling units <br />Forced air systems <br />� Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />1 6chaust (an <br />Heat pump <br />.? Unit heater <br />� Boiler <br />Re(rigeratlon <br />� Woodstove <br />. Other — <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �105 <br />I hereby ceritiy that I have read and ezamined this application and know the same to be Uue and comect. AII provisions of Wws and <br />ordinaces goveming lhis type of work will be complied wilh whether specified herein or not. The grantirg of a permit dces not presume <br />to give authonty to violate or cancel the provision of any other staM or local law reguiating construction or the performance of <br />construdion. That I am authorized by the owner of this property to perfortn the woitc for which application is made and I co:nply with the <br />Stale CoMractors Law 1827 RCW and 296.200 WAC. <br />I i � -'� .c-�� [' (, �� <br />r. . _,,.____,.._� _ ..............,,we�e�� Date �. <br />