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PERMIT APPLICATION <br />GITY 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 <br />SI?[ ADDRESS PARCEL TAX I.D. # <br />9��! 5'l� � P� svv. GciSG���OcXiO��C�� <br />LEGAL LOTNO. BLOCK TRACT <br />�a�rs E�w�-�o� ��N 5is �- �� s�v c� <br />TENANTNAME <br />CONTRACTOR <br />D� d��/r� ��._c��ti,�G-,f.HrEr <br />CONTR.UCENSEI.� . . . <br />USE OF BUILDING <br />WORK DESCRIPTION <br />�Ep�ycE <br />�c.G�-77'�-I � <br />PERMIT # <br />1Y10? cr3- <br />y2� -Z$'Z 03C, � <br />CONTACT FOR PE,�Rj' IT� PHONE <br />�l�(A-iJ ,%Cr49Guv'� 4�-775�0 ��'�' �� <br />ADDRESS CITY2IP PHONE <br />l�6(� i'�l� �0 �3 �9 �a5n��s��/��i <br />HEATSOURCE <br />Electric _ Gas <br />CONTRACT PRICE OF WORt: <br />Olher � � � �� �/ V <br />�x�snn�G- c�er/�dG �'2,,,�,��� r��iTH �/�r-tJ <br />FLl �Nq eE, <br />NO. I TYPE OF FIXTURE OR ITEM <br />Tailet <br />BalhWb <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc. ) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease irap <br />Roof drains <br />Olher <br />NO. i TVPE OF FIXTURE OR ITEM <br />a <br />NC — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas f replace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigera:ion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined ihis application aul know the same to be true and correct. All provisions of 6ws and <br />ordinaces 9overnin9 ihis type of work will be complied vrith whether specifed herein or not. The granting of a pertnit does notpresume <br />ro give authoriry to violale or cancel the provision of any o�er state or local law regulatng wnstruction or the pertormanceo! <br />construclion. That I am authorized by the wner of ihis properj to perform the work for which appiication is made and I complywith the <br />State CBntRactors Law 1827,F2GW dD�O WAC- <br />