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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-�57-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # <br />c�� i t�-�T�.F,2�s (}�� pr.4�i � oc��S���II o <br />LEGA LOT N� BLOCK TRACT OR SUBDIVISION N <br />MIT # <br />Co(o <br />11n tC }a '�C1� w(�-� 4 Ij .T G� �C� wL �w.� !�G i�l�= Ev�.'7-E-7T `�' Z" � <br />TENANTNAME CONTACTPORPERMIT PHONE ,Ze�� C J-3 J <br />7 <br />fl�/!�r ��.i'S U �'''�L.IvN E-MAIL <br />'�ATffA� �-- <br />� ..,-- .� `. �2_ <br />CONTR. LICENSE 8 <br />USE OF BUILDIN3 <br />WORK DESCRIPTION <br />� ��_ y� l �� 7 <br />rZ r' N �/1" �� <br />�1 l9 r�-/H�c : <br />NO, I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Waler heater <br />Sink (service/barhnop/etc.) <br />[3ackllow prevenler <br />Urinal <br />Drinking I'ountain <br />Roor drain <br />Grease Irap <br />Roof drains <br />O�her <br />HEAT SUURCE GON I KAI: l Ynw� �+r �r�n� <br />_ Electric _ Gas _ Other <br />i <br />�i L L�. v/ N G �..J <br />-T � �, n• N � /tT .� Q <br />�� � <br />�-�r�HC�t <br />NO. I TYPE OF FI%TURE OR I7EM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas firep'ace <br />Gas range <br />Clathes dryer <br />Range hood <br />Exhau�tfan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />� <br />� hereby certify Ihat I have read and examined this aaplication and know lhe same to be true and correct. All provisions of laws and � <br />ordinances governing this type of work will be complied wilh whether specified herein or not. The granting of a permit does nol presume <br />to give aulhority to violate or cancel ihe provision of any other state or locai law regulating wnstruction or ihe periormance ai <br />construction, Thal I am aitlhorized by Ihe owner o( Ihis property lo perform the work for which application is made and 1 comply with the <br />S�ale Conlraclors Law 18 7 RCW and 296.200 W/�C. <br />�., {��.---_- c- � i -� � � , <br />`� � <br />Signatlue ot Uwn rlCon�rac r/Authorized Agent Date �/ <br />7 <br />/ � <br />u <br />