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P�.r2MIT APPLICATIC.J <br />CITY OF EVERETT PERMIT SERVICES 3��f_65 <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org D�SO ,3—ODZ <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8� CREDIT CARGS ARE NOT ACCEPTED <br />51TE ADDRESS PARCEL TAX I.D. # PERMIT # <br />//// '3 z.-�.� �'r.� E� , UD 5�37s73 Zo�7o / p�=,o3 -�,a <br />LEGA LOT NO. BLOCK TRACT ���-G� %Ji v' N P�1- o /k -3 <br />DESC. . l] ' 2 (� - U/- bc/ s o FT aF LoTs /7- /R -/�% <br />OWNER ADDRESS CITV/ZIP PHONE 33f -,g, <br />��,; ProPe�-t�c.r L LC� yo2� Hv+1t #/ a 5� Evu��f u�A 9��'0 <br />TENANTNAME <br />� ,'�/Ll' <br />CONTRACTOR �.Jc / <br />� <br />CONTR. LICENSE # <br />ICONTACT FOR PERMIT <br />L�'l. ti✓�v f0 ��'7501-� <br />%y�c-L.- ADDRESS <br />PHONE <br />S' �s--3� y - ���y <br />� 5�.� s- -� o�- r � i� <br />_. V/ZIP PHONE <br />E3-c-,w�..�-G'�„-. 220 / �i G✓. �o-�t.r�,i /Zai. <br />C�l�-�.-�-�c'� G✓.4� <br />USE OF BUILDING <br />�� l�fi �,-� <br />WORK DESCRIPTION <br />.l�9-��� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />8athtub <br />Lavatory (wash basin) <br />Shower <br />Kit�hen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />��-T- <br />�27- 7�i.�i� <br />HEAT SOURCE CONTRACT PRICE OF'NORK <br />_ Electric _ Gas _ Other <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unil heat+ir <br />Boiler <br />Refrigerati�:� <br />Woodstove <br />Other _ <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />I hereby ceritify that I havc� read and examined this apc�ication and know the same to be true and cortect. All pmvisions of laws and <br />ordinaces governing this type of work will be complied with whelher specified herein or not. The grantlng of a pe�7nit does not presume <br />to give aulhoriry to violate or cancel the provision of any other s!zte or local law regula0ng construclion or the pe.rformance of <br />construction. That I am authorized by lhe owner of this property to perform the work for which applicaGon is marfe and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />