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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-757-8810 – FAX 425-257-8857 – www.everettwa.org <br />!, SITE ADDRESS <br />�� I � �� �� � S� <br />LEGAL l0T NO. <br />I DESC. <br />OWNER <br />� �� ��� .���� � ���� <br />TENANTNAME <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />�'��-�" 0'� `>� � >1 C 11 l''I _� 'J !: <br />BLOCK TRACT <br />ADDRESS C <br />�� I 7•� � S� =S-� Y t' � 1� <br />� CONTAC'f FOR PERMIT <br />��LI ��li� I� <br />CONTRACTOR .f-{ w �,�i`-�ryi,� 5(�✓���,1 <br />JJ <br />CONTR.LICENSE# ill,r� n I� C-�-Gj ����If <br />ll w / v ��_�_ r � <br />USE OF BUILDING <br />„ � <br />�,1� ;-�, �� i i i �� !�� 1 <br />Fur�r� � c-E r���D <br />.- <br />� <br />� <br />'�'J� I y� �� 3 ��.. <br />PHONE <br />�' �1 �-7 _ <br />-7? <br />ADORE55 �C�O I�� t��J ��: ����I.�� CITY2IP PHONE <br />�1 � 3�:,��-�3� l7)L� <br />`' �("lii'��j� f�rn%,�d�3 <br />HEATSOURCE <br />_ Electric ,�� Gas _ Other <br />CONTRACT PRICE OF WORK <br />��LiL� — <br />�t1�.,EZ (-h��,q-p�R C� N J�S-�1 N� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Dathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchr.n sink 8 disposal <br />�ishwasher <br />Cbthes washer <br />Laundry tray <br />Sink (service�badmopletc.) <br />8ackflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />_ Grease trap <br />Roo( drains <br />Other <br />NO. <br />TYPE OF FI%TURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas hreplace <br />Gasrange <br />Cluthes dryar <br />Range hood <br />Exhaust fan <br />Heatpump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY CF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y that I have read and examined lhis application and know Ihe same lo be irue and correct All provisions ol laws and <br />ordinaces governing this type of work will be complied wilh whether specified herein or noL The granling of a permit does not presume <br />to give authorily to violate or cancel the provision of any other state or local law regulaling construction or the per(ormance o( <br />construclion. That I am authorized by the owner of ihis property to perform the work for which application is made and I comply with lhe <br />State Contractors Law,78.27 RCW and 296.200 WAC. / % , <br />1 <br />