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PERMIT �4PPLICATION <br />CITY OF EVEREI7 PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-2:57-8857 — www.everet[wa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �..�.�(' `�D� <br />SITE ADDRESS yr, �JL i,�i <br />/��s ��z I � ,� - �: <br />LEGAL L0T NO. <br />DESC. 2 � <br />,ci,�i�i�� Azctc�,v,� <br />TENANTNAME <br />�L' <br />BLOCK <br />y <br />:1 <br />CONTR. LICENSE N ��U�= ��� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />PARCEL TAX I.D. # <br />v�o7�� vc�o 0 <br />TRACT OR SUBDIVISION # � <br />9 �:P �, <br />CONTACT FOF PERMIT <br />PHONE <br /># <br />� 3 - z��v <br />y�.r3v��Ja��. <br />I E•MAIL <br />i �- <br />�� <br />HEAT SOURCE <br />Eleclric _ Gas _ Olher <br />;.;� � <br />ryo �J�n�.�.-�.- �-� <br />�� � <br />N0. I TYPE OF FIXTUFiE OR ITEM <br />�' - <br />.�3- <br />i <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washei <br />Water healer <br />Sink Iserviceibar/mop/eic.) <br />Backllow preven�er <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grcase trap <br />Roof drains <br />Olher <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURF: OR ITEM <br />1 <br />� <br />� <br />A/C — air handling units <br />Forced air systems <br />Gas pip�ng <br />W ater heater <br />Gas lireplace <br />Gas range <br />Clolhes dryer <br />Rangehood <br />Exhauslfan <br />Hea� pump <br />Unit heater <br />Boiler <br />Rehigera�ion <br />Woods�ove <br />Olher __ <br />CI7 :` OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y ih2t I have rrad and exanined this application and know the same to be irue and coriect. All provisions ol laws and <br />ordinaces governing this ty�e of work wi'� be complied with whether specified herein or noL The granting of a permit does not presume <br />to c�ive aulhority to violale or cancei Ihe provision of any olher slate oi locai law regulating conslruction or the performance of <br />conslruction. That I am pulhorized b; Ihe owner ol this property lo perform the work lor which applica�ion is made and I comply with ihe <br />Slate Co�lrac�ors Law t8.2�R�SV and 296.200 WAC. <br />., ����o� <br />; i.��- �,�µ1�.�%Grfi't-.�-.�— <br />Sign ure o� wnedConlrac;bi�Authorized Agent iUa�e � <br />�' <br />