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�� <br />� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8057 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # <br />� S2`�.S'/ S�� j�l, - Sc.,l ,?Ysi=m !� `� �� ZCc�oOn .:� c�po <br />LOT NO. BLOCK TRACT <br />� u /�Dn7-o WlL(ou1 <br />��rrroe. ;�+�r-,�r `�. �Th,-,�' ��2y-S�S= (�� S';� �v.sn.r�r 9�a.�= <br />TENANTNAME CONTACTFORPERMIT PHONE <br />� i � <br />SFi:�-i � �,�-,�_r- 02 �ia-��„�, 2j�2s �?-i 33�' <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />srN-i.�t.f 1.✓/}N� s-a1�i1.•-� td �19�/- %��; �r. 5�., 1`tiuK,u�,-v q�i z�s� <br />�oNT �n"� s�,,✓ � � Ct �� P Z �Di13/l.>7� �/.Z.� 3`/�-c7 9`d 1 <br />USE OF BUILDING <br />R�i , �� �.�� <, <br />Si,Jb(ch <br />HEATSOURCE <br />Electric ✓ Gas Other <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />�r j�l J O�Z. U� �. n 1�-CY L S�'-1-c:, r�Urr� i.11S i�-�..."� <br />,�'�,..ni�j� t�pS� r.�-r�t/?�� �sti y�S � <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet �, <br />BathWb (!.?��% <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/barlmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />O�her <br />/ /� � <br />�) L ) , � IJ� <br />NO. <br />�� <br />� <br />Uv o <br />I}{C_G�- ! �� <br />MECHANICAL <br />TYPE OF FI%TURE OR ITEM <br />A/C — air hantlung units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />�as range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7706 <br />I hereby ceritify ihat I have read and ezamined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That 1 am authorizecl by the owner of this property to perform the work tor which application is made and I comply with the <br />State Conhactors Law 1827 RCW and 296.200 WAC. <br />I�Z <br />