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� cRMIT APPLICAT�,1N <br />Cd'�Y OF EVERETT PERMIT SE'?VICES <br />3200 CEDAR STREET, EVERETT, WA y8201 <br />425-2�7-8810 — FAX 425-257-8857 — www.everettwa.org <br />A?PLICATIUNS ARE ACCEPTED FROM 8 AM TO 4 PM r�_. �� ��� <br />SITE ADDRESS PARCEL lAX I.D. # PERMIT # <br />�'�/OS SJY�' S� �r ��II—o� <br />LEGAL LOT NU. BLOCM:. TRACT OR SUBDIVISION # — <br />DESC. <br />OW4ER ADDRESS CITY2IP PHONE <br />�.�L�L� L..� //.��/�n:�N >t''I�✓.:,ti l�-l(/S S(�T�'i��5�_ l✓«f7! ��=G� �12� 339 S39`� <br />TENANT NAME CONTACT FOR PERMIT PHONt 4 2 t i3 � S3 �9 <br />H2a LS/ 7/// <br />i��. � �� L <br />���/_-)' e-Ma� D� I, //�y� a�!.«•- <br />CONTRACTOR ADDRESS GTYIZIP P�— <br />Uw�1�r <br />CQNTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />HEATSOURCE <br />Electric K Gas Other <br />CONTRACT P?ICE OF WORK <br />Che�.l<�C Jv'� C.i'I'�'1i�t�� 4.>'S i��J v�c�<[ � Y✓1(ii/� �U CYr/.:ci^P� yU.r'c�C'_E1 <br />� � J <br />� <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />Tuilet <br />Pathtub <br />Lavatory (wash basin) <br />Shawer <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Waler heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roo( drains <br />Ol'ner <br />N0. <br />� <br />. <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas tireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y lhat I have read and examine� this application and know Ihe same lo be true and correcl. All provisions of laws and <br />ordinaces goveming this type of werk will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />lo c�ive authoriry to violate or cancel the provisioi of any other stete or loral law regulating consWction or lhe performance of <br />construction. Thal I am authorized by lhe owner �f this property t� perform the work for which appiication is made and I comply with the <br />Stale Contraclors Law 18.27 RCW and 296.200 WAC. <br />-�J�`%/ r i /�u I <� <br />Signalure o( Ow�edContraclor/Aulhorized Agent Date <br />� <br />