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PERMIT APPLICATION <br />CITY OF EVERElT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FHOM 8 AM TO 4 PM <br />SITE ADDRESS <br />� : � � � , � - r <br />LOT N0. � � BLOCK <br />DHSC. <br />PARCEL TAX I.D. k <br />TRACT OR SUBDIVISION p <br />PERMIT # <br />L U.`1171 - o� `� <br />�'IL IL �Z.�if�C '_i��� SI .=V4�2�i C�,�i..Ul i?C7G;�7/S�Ci7Cif� <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />CONTR.LICENSEp � [� <br />� <br />USE OF BUILDING <br />t�E`>T.i)�a) _R� <br />AOUHESS <br />��n•+'t�+l.li! S�y� j%nY � r� S�' <br />L �I k^ i �-3J <br />HEATSOURCE <br />� Electric _ Gas _ Other <br />WORK DESCRIPTION n <br />V ''.; r�0. .c U � . C (� (7�CLLy I Z' �i'y, (' �- � N ' � �C..( <br />1 ' J., <br />NO. I TVPE OF FIXTURE OR ITEM <br />� Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />_ Ki�chen sink S disposal <br />_ Dishwashcr <br />Clothes washcr <br />W, tcr healcr <br />Sink (scrvicc/badmory'etc.) <br />Dackflow preventer <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grcasc trap <br />Rool drains <br />Other <br />rcin,:� t� <br />�\Sc`.i�:. `��.11�-L <br />CONTRACT PRICE OF WORK <br />�l � 7.� �= <br />N0. I TYPE OF FII(TURE OR ITEM <br />A/C - air handling units <br />Forced air syslems <br />?� Gas piping <br />�_ W21cr heatcr <br />J_ Gas fireplace <br />� Gas range <br />Clothes dryer <br />Range hood _ <br />Exhaus� lan <br />Heat pump <br />Uni� heater <br />Boilcr <br />Relrigeration <br />Woodstove <br />CIN OF EVERElT LOCAL SALES TA% COOE IS 7105 <br />I hereby ceritity Ihat I have read and examined �his applicalion and know �he same to be �me and correct. All provisions of laws and <br />ordinaces c�oveming ihis rype of work will be complied with whether specified herein or not. The granting of a permil does not presume <br />to c�ive authority lo violale or cancel the provision ol any other state or local law regWating conshuction or the pedormance oi <br />conslruction. Thafl am authorized by the owner of lhis property Io pedorm the work lor which application is made and I comply with ihe <br />Slatc Conlractors Law 78.27 RCW and 296.200 WAC. <br />, <br />" ��� I�;�US�, <br />SignaWre pl OwncriContractodAuthorized Agent —�te <br />