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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SW <br />BLOCK <br />OESC. <br />vRnk a�d► ��I�u�e�h CoRwi� 2yD <br />PARCEL TAX I.D. i <br />�issooeo aoao <br />�landt <br />PERMR 11 <br />/ �v, � , o � .Z <br />�D� v. # 2- <br />� sw Gvr�r�F °16�ca y�,t',k�, og�o <br />�%ANTNAME ID��n�`� ���i�i�w1��17 Z� ��,'f a3 <br />A , <br />CONTRA�TOR � rvG ��, ADDRESS CITYTP PHONE <br />CON7R.LICENSEN (��oKcci afS'6D ��Box 62b �� �LS, kzti� l0�°l <br />USE OF BUILDING <br />Sr�+•�l� �ami� <br />HEATSOURCE <br />_Electric �Gas_Ofher <br />CONTRACT PRICE OF WORK <br />I SO' 20D �. <br />WORK DESCRIPT O , • <br />T�„b 5'fb� ��d�fi'�n- 1=�do �iitihin�ut�h}�,�Lo. an�l Rel�ca�s. �i�i� �•a�, Ff, <br />N�u �p'tt .Fl�at, bQ,clRoo�n, ba��hti.b►r► Van�. wnrhas.h <br />NO. � TYPE OF FIXNRE OR ITEM <br />"L Toilet <br />� Bathtub <br />� Lavatory (wash basin) <br />Shower <br />�— IGtchen sink 8 disposal <br />= Dishwasher <br />� Clothes vrasher <br />Laurdry tray <br />-� Sink (servicelbarhnop/etc.) <br />Backflow preveMer <br />Urirral <br />Drinking Founfain <br />Floor drain <br />Grease frap <br />Roof drains <br />Other <br />NO. � TYPE OF FI%TURE OR ITtM <br />A1C - air handling unils <br />Forced air systems <br />Gas Pfpin9 <br />Water heater <br />Gas firaplace <br />Gas range <br />Clothes dryer <br />Rarge hood <br />Exheustfan <br />Heat pump <br />Und heater <br />Baler <br />Refrigeration <br />Woodsrove <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3106 <br />I hereby ceritify that I have read and examined this appGption arxl know the same to be true a�d mrtect All p�ovisions of laws and <br />ordinaces goveming this type ot work wiq be complied wRh wf�ether spedfied hereii or not The gfar�Ong of a permit does rat presume <br />to give autlwnty to violate or cancel Ihe provision of any other sfa0e or bpl law regulating construcUon or ihe performance of <br />construction. That I am autlwrized by the owner of this property Eo perform tlie work for which application is made ard I comply with the <br />State Contra Law 18.27 RCW and 296.20L WAC. <br />2���ob <br />Si atura f Ow dContractodAuthonzed Agent Date � <br />1 � <br />