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PERMIT APPLICATION <br />C1TY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRE[T, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www•everettwa.org <br />APPLICAI'IONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # <br />i�5�5 J�L��AI� W �Sl�rr.'��ii i..i1`J]/-1 �p5-JJ��2.Du�UG��G <br />PERMIT # <br />) 0`�� G� `�0 L <br />LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION # S`, U V� iL �q p n� � �` �+� ' <br />DESG Z D - "ti — I <br />ADDRESS CITYIZIP PHONE <br />OWNER � <br />� M��}ki3A,� )22 9� I�y l;, 5,— Si,l Mu�c�Lir-� �/Zi 7��1'�33 � <br />I CONTACT FOR PERMIT PHONE � <br />TENANT NAME �- z j -j ) u j� 3 3 I <br />/� _ I�� %-� I< I� i�-��L. E-MAIL <br />ADDRESS CITYIZIP PHONE <br />CONTRACTOR �I, <br />CONTR. UCENSE & <br />USE OF BUILDING <br />wnRK oESCRIPTION <br />i� �> �� ��� `� � I� <- h <br />� �: 1� I � 1.; iv <br />ryp. I TYPE OF FIXTURE OR ITEM <br />�__ Toilet <br />Bathtub <br />Lavarory (v:ash basin) <br />�_ Shower <br />Kilchen sink 8 disposal <br />Dishwashrr <br />Clothes washer <br />Waler healer <br />Sink (service/bar/moplelc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roo( drains <br />Olher <br />'�n �-�. �� C <br />_ I 17 <br />HEATSOURCE <br />� Electric _ Gas _ Other <br />�2� M 5 �� ✓� <br />q� �� ��N S <br />CONTRACT PRICE OF WORK <br />\rJ'"�l �'i� <br />i3 /i i t-t {2 �. M <br />S I°�1 c c � s ;'i �1 i� � �J <br />NO. I TYPE OF FIXTURE OR ITEM <br />.VC - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas ran9e <br />Cblhes dryer <br />Ranga hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerili(y that I have read and ezamined this application and know lhe same to be true and correcl. All provisions of laws and <br />ordinaces govcrnin� lhis type of �.vork will be compGed �vith wheiher speci(ied herein or noL The granting of a permit does nol presume <br />to 9ive aulhority to violate or cancel tha provislon ot ��ny other stale or local law rogulating construction or the performance of <br />consUuction. T al I am aulhorized by lhe owner of this pruperty lo perform lhe work tor which application is made and I comply with lhe <br />I State Contrac rs Law 18.27 RCW and 296.200 W AC. , /' <br />��1 c.-" ���� 6��'i,��ti <br />Signature o � nedConlraclod thorized Agent Da! 1/L <br />1 <br />� . .------� ----- <br />------- --- <br />