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P�RMIT APPLICATIC�N <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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />LOT NO. <br />PARCEL TAX I.D. # <br />Pl. Sc,� <br />BLOCK TRAC7 <br />PERMIT # <br />o�rr- <br />DESC.r I I <br />1 <br />OWNER ADDRESS CITY2IP PHONE yZ5 34�0 <br />Paneen �av i d 5o n 3208 52nd P� S� �verd�-, yszol �i58 <br />TENANTNAME CONiqCTFORPERMIT PHONE <br />I�bt' e L�,u�.rS �{25 2 5�i �o �o�ok� <br />CONTRACTOR (, ` ���DD��Q ��� 21P PHONE <br />cmc�ea-lir� l�c. <br />CONTR. LICENSE # _ _ _ �T y �i'2J 2S9 �ddoC-� <br />- - .,�, .,._ . <br />USE OF BUILDING <br />HEAT SOURCE <br />Electric �Gas Other <br />CONTRACT PRICE OF WORK <br />. 1� C7 <br />WORK DESCRIPTION <br />Ihstu,61 90+ �rr�ace t 50 5allev� k420 <br />- Run o�s 1,�`�.Q, �''�rePlctces, furnae��N�re+�nvii' �nce <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shawer <br />Kilchen sink 8 disposa� <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas Tireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove L l" <br />Other �{{e �pr' TU � 1�i�+ <br />��� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I I�ereby ceritify lhat I have read and examined this application and know the same lo be true and correct. All provisions of laws and <br />ordinaces goveming this type o( work will be complied with whelher specified herein or not. The granting of a permit does not presume <br />to give aulhority to violate or cancel lhe provision of any other state or local law regulating wnstruction or the performance of <br />conslruclion. Thal I am authorized by the owner of this property to perform the work for which application is made and I wmply with lhe <br />State Conlractors Law L8.27 RCVJ and 296.200 WAC. <br />Pi �Q.1.1 Dlir�' � �' <br />