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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 8 AM TO 4 PM <br />SITE ADDRESS <br />C�a-a W�'YMO te I� ✓2- <br />LEGA LOTNO. BLOCK <br />DESC. <br />OWNER <br />a r 'v <br />TENANT NAME <br />�,��,tP�, <br />622 q <br />CONTR. LICENSE M <br />1e � a r-{ <br />USE OF BUILDING <br />WORK DESCRIPTION <br />CaS� � �� - 6yDZ <br />NO, I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & dis�>osal <br />Dishwasher <br />Cblhes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Uiinal <br />Drinkin� Fountain <br />Floor d ain <br />Grease rap <br />Roo� drains <br />Other <br />IPARCEL TAX I.D. p <br />TRACT OR SUBDIVISION N <br />ADDRESS CI <br />CONTACT FOR PERMIT <br />��iv�o rP W � t ���e <br />HEATSOURCE <br />Electric Gas Other <br />PHO� ; <br />E-MAIL <br />: u� � <br />PERMIT N <br />-(�2z Z <br />W • <br />CONTRACT PRICE OF WORK <br />�e �o� 5`icLc-� 5-1r���e� hv�,��" �o �erm;f� <br />rr.a <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TA% CODE IS J105 <br />I hereby ceAify that I have read and examined this application and know ihe same fo be true and cortect. All provisions of laws and <br />ordinances goveming this type ot work will be complied with whether specified herein or not. The granting of a pertnil does not presume <br />to give authonty to violate or cancel the provision of any other state or local law regulating construction or the peAormance o( <br />construction. Thal I am aulhorized by the owner of this property to periorm the work for which appiication is made and 1 comply with the <br />State Contredors Law 18.27 RCW a�d 296.200 WAC. /� <br />-�1 11 � !ia✓c Qe�m;JS��^ b�{ vwnec' ljAr�sju�C� <br />� G.-, rs, i_ ,.r, i� <br />UtlIC <br />� 4 �, �o,� �.� ��., �� z �d�ro <br />