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�,� �✓i,�' �,�"J PERMIT APPLICATION <br />- I;� �,� CITY OF EVERETT PERMIT SERVICES <br />��V ` J J,� 3200 CEDAR STREET, EVERETT, WA 98201 <br />� ,L 425-257-8810 - FAX 425257-88�7 - www.everettwa.org <br />APPLICATIONS Af�� ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRcE�SS PARCEL TAX I.D. p <br />S")O�, •>.�n�:.� L-�� �`62�7 1�0�V-11��061, AZc�V <br />LOTNO. � BLOCK � TRACT <br />PERMIT 8 <br />�� <br />1-�c�...��.�`. E-1.�;..�t� �-,os �«s��- ��% f� ��H- ��z�3 �tzs-�n- ��c� <br />TENANTNAME (, CONTACTFORPERMIT � PHONE <br />1,� t I l" c.�•�n �,-. L,v�.4� ��-,2 �o �'v -� 11< <0 5��b <br />CONTRACTOR`, /��f��h���rr7J CU�r�`��� AOORE55 .iSJ,� �y/���(•CL <br />V <br />�(�� «'H�t �Ly �. <br />CONTR. LICENSE M „� . , , p � <br />USE O� BUILDING <br />WORK DESCRIPTION <br />�.�Vl�.aS�C'. li ti'�'� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry Iray <br />Smk (service/badmopfe�c.) <br />Backllaw prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ 6lectric �! Gas _ Other <br />/" <br />� �� ���L� l.i.'G� C�., <br />NO. <br />I�P PHONE <'�� � <br />iJ <br />;./'[tl�i�� f� 5, y.)b'� <br />���'?, 3Y <br />CONTRACT PRICE OF WORK <br />S (!' � `8� <br />�i .. <br />\��— � � <br />`. <br />MECHANICAL <br />TYPE OF FI%TURE OR ITEM <br />A/C – air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas 5replar.e <br />�asrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Ilnit heater <br />aoiler <br />Retrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby centity that I have read and examined this applicalion and know the same to be �rue and correct. All provisions of laws and <br />ordinaces goveming thls rype of work will be complied with whether sped5ed herein or nol The granling of a permit dces not presume <br />to give authonty lo violale or cancel the provision of any other sta�e or local law regulaling consUuction or the pedormance of <br />consWction. That I am ainhorized by the owner of this property ro per�orm the work for which app�ication is made and I comply with the <br />State Contractors Law 1627 RCW and 296200 WAC. <br />� ` - �-��, _ L,L: . ��.1�L �.^ - S `(.� � <br />����ai���a nr nwnerl ontractodAulhonzed Agent � DatN ^ <br />