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PERMIT APPLICATION <br />CITY OF EVERETT PERMtT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPI.ICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />'/.^,'1-,. � i l //�/(/�� :��V <br />/i.� � �'���� <br />LEGAL LOT NO. BLOCK <br />OWNER�,. � � <br />K.',��-!l,r/ l,,i l..,,;;:, <br />TENANTNAME <br />C NTRACTOR , U��l � CVQ?,� <br />PARCEL TAX I.D. # <br />TRAC? OR SUBDIVISION # <br />J�_�,,�-� _� <br />CONTACTFORPERMIT <br />PHONE <br />PERMIT # <br />�� <br />ios�i �R s3� A�I;�y�4 yZs 3z� �8�5 <br />CONTR.LICENSE# /�C`^� J`�'O '��.���n� 9yv.23 <br />� �-�.� �i�l� � � � , <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />�1(`rf, i�63� <br />..�CA<��il'(� _Eleclric _Gas_Other <br />WORK DESCRINTION <br />N0. I NPE OF FIXTURE OR ITEM <br />Toilel <br />G�thlub <br />Lavalory (was!; basin) <br />Showcr <br />Kilchensink&disposol �"��''�� <br />� Dishwashcr <br />Cblhes washer <br />Water healer <br />Sink (service/bar/mop/elc.) <br />Bock(low prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Root drains <br />Othcr <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC — air handling unils <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaust 1an <br />Heat pump <br />Unil healer <br />Boiler <br />Re(ri�eralion <br />Waodslovc <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />I hereby ceritify Ihat I have read and examined Ihis application and know tlie same lo be true and correct. All provisions of laws and <br />ordinaces governinc7 this type of work will be complied wilh whether specified herein or noL The granling of a permit does nol presume <br />lo yive authority to violale or cancel Ihe provision of any other state or local la�v regulating construction or the peAormance ot <br />construclion. Thal I am aulhorized by the owner o( this property to pedorm the work (or which applicalion is made and I comply wilh the <br />Slale Conlraclors Law 18,27 R� nd,296.200 WAC. <br />, ., . _ �'r � C7. :l ¢/ <br />