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�-ERMIT APPLICATIt�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 FM C�� s�� <br />SITE l,DDRESS �r!"� PARCEL T,4)i I.D. # PERMIT # <br />/o/z 3Sf`' S¢. i8zo! v0`l5/SooSooSo/o2 I��)$(��'v��"l <br />LEGAL LOT NO. D� pBLOCK TRACT OR SUBOIVISION #�1 <br />DESC. i�Z�3 D!('�ODiD�O F'�ilt��a Z''�� /7�� f"� �v�ert.� <br />OWNER AD�RESS CITYIZIP PHONE yLs- <br />�A �. .�,o-��r� �ss� Easf��,, n� ,�'�.��/�BZ�s �sy -srzP <br />TENANTNAME CONiACTFORP[RMIi PHONE �(2S-`/S�I- SSZ$ <br />EuK�EI' l�2".oaG I L. L, l, • �JQ � %%'l / tL(^C � I E-MAIL <br />CONTRACTOR ADDRESS CITYIZIP PNONE <br />CONTR. LICENSE # LCIi� �� 2 LO � i L D <br />USE OF BUILDING HEAT SOURCE I�CONTRACT PRICE OF WORK <br />SfOCNG (� X Eleclric _ Gas _ Olher Zo� o D p <br />WORKDESCRIPTION �7e��u�y /a0�ts_ � �w�.�dp�� ,�R.FN � �Q��% ,g�fh� SO% NCWA <br />Nttn/ V/nyl f C..� �-f'� NGv Tri w� � rLt,•r,✓ w�1�0✓ S <br />NO. I TYPE OF FIXTURE OR ITEM <br />z <br />z <br />Toilet <br />Bathlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washcr <br />Waler heater <br />Sink (servicelbarlmop/etc.) <br />Back(lo��• prevenler <br />Urinal <br />Drinking Faunlain <br />Floor diain <br />Grease trap <br />Roof drains <br />Other <br />NO. I 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 />�Clofhes dryer <br />Range hood <br />� Exhausl (an <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeralion <br />Woodstove <br />Other <br />CITY QF EVERETT LOCAL SALES TAX CODE IS 7105 <br />� hereby ceritify that I have read and examined lhis application and knolv lhe same to be lrue and correcL All provisions of laws and <br />ordin2ces goveming this rype of work will be complied wilh whelher specified herein or noL The grenliny of a permit does not presume <br />to give aulhority to violate or car.el ihe provision of any other state or local law regulaling construction o, the performance of <br />conslruction. Thal I am aulhorized by the owner of lhis property tn pertorm lhe work for which application is made and I comply with ihe <br />State C ctors Law 1827 RCW and 29�620�0 W�AC. <br />/ � G—• ✓%. ✓Jf��f� ��//�1 �//Z /fJJ� <br />�z <br />/� <br />