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PE�MIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERE"(T, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />SITE ADDRESS <br />� f I � <br />LEGAL LOT NO. <br />�ESC. �.,�_ <br />OWN[R <br />�O(3iasilf ��Ll�lu <br />TENANTNAM[ <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I,D. # <br />�•�' 'UG �^� � �'C��/ U lc)C�'zc�OYc�C) <br />BLOCK TRACT <br />e, <br />CONTRAC70R �(� Cp u ST Rt.�T� U�7 <br />Siav��i.�.�t,G <br />CONTR. LICENSE # <br />�.c�oN<:.c�C,aP <br />USE OF BUILDING <br />SFR <br />WORK DESCRIPTION <br />[ c� s r�1 cr ��t— N E�� S'F R. <br />NO. I TYPE OF FIXTURE OR ITEh1 <br />Toilet <br />Balhlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />Sink (service/bar/mnp/elc.) <br />Backllow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Itoa( drains <br />Other <br />Wa�Oli G R%5�r <br />�� 1 Co�(3y <br />CONTACT FOR PERMIT <br />r��i �rsYdv <br />1���, (�- // - ���-� <br />P�RMIT # y� 9 <br />� V��—Vi.�/ <br />PI10NE <br />L/:�-S <br />as2-�'ooD <br />PHONE <br />>;�E �.�.Qus �ra5•a43-5�52_ <br />ADDRESS CITYIZIP PHONE <br />(�m� L-15010 �-��.5-�43 -55'„C,Z <br />asa� a��.�w9y <br />£�42�'�T � Y�o� <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric �' Gas Olhor `� 1 3(J�OD U <br />Zz9 <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas (ireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heal pump <br />Unit heater <br />Boiler <br />Re(rigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby cerilify thal I have read and examined lhis applicalion and know Ihe same lo be true and correct. All provisions o( laws and <br />ordinaces goveming this type o( work �vill be complied with whelher specitied horein or not. The granling of a permil doos not presume <br />�o give authority lo violale or cancal lhe provision of any olher slate or local law regulating wnslruc6on or the performance of <br />wnstruclion. That I am authorized by the owner of this property lo perform the work for which application is made and I comply with tho <br />State Contractors Law 1D.27 RCW and 296200 WAC. <br />0���% <br />�/Z <br />