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-� <br />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 S"� l�/ <br />SITE ADDRESS ,��1�� _ � f <br />L[GA LOTNO. <br />NAME <br />(:UIVIH l.l N <br />�� . , rIL,�;w� <br />CONiR. LICENSE 11 . _ . <br />USE OF BUILDING <br />PARCEL TAX I.D.11 <br />cR-�2 �= G 0 � <br />;K TRACT OR SUBDIVISION �I <br />ADDRESS <br />�1�1=T�yl�� I�(z E <br />I CONTA TFORPERMIT� <br />�� <br />PERMIT fl <br />`�(�55'• ��.5� <br />f]:I�7S1� <br />Ix,.1!L� <br />S�PRE55 GI I nar rnunc yt��.79y _ <br />�� <br />5��,� ,, Y}'IAI►� �� ��l�or%l�G ���27L 73cah <br />HEAT SOURCE � CONTRACT PRICE OF WORK <br />�Electric _ Gas _ Other � Z��� 0 ,� _ <br />WORK DESCkiPTION ,II � <br />� �U �-ti,4�C Gt��t� �� D U I <br />NO. � TYPE OF FIXTUIiE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kdchen sink E disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (servicelbar/mop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Ploor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYFE OF FIXNRE OR ITEM <br />NC — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woods�ove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I hereby certify that I have read and examined this application and know the same to be irue and correcL All provisions of laws and <br />ordinances governing this type of work will be complied with whether specifed herein or noL The granting o( a pertnit does not presume <br />to give authority to violate or cancel ihe provision oi any other state or local law regulating construction or the peAortnance ot <br />construction. Thal I am authorized by the owner of thi.� property to perform the work for which application is made and I comply with the <br />State Contractors aw 18. 7 CW-arW2y6200 WAC. <br />' � .+EC'� �r 0 <br />Signature f iedCoM ctor/Aulho zed Agent Date <br />