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PERMIT APPLICATION <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 PM <br />SITE ADDRESS <br />S5`=1CCv 8.�-- �L Sc' <br />LEGAL LOT N0. BLOCK — <br />DESC. <br />OWNER <br />� , <br />� l.l /' L ,l�j� �t-Ur� � ��L%(n <br />PARCEL TAX I.D. # <br />UC� 5�s �a�c <br />TRACT OR SUBDIVISION # <br />., �{'— ��L �7 C �c <br />PERMIT # �y� <br />MwIZ'�7'� <br />=�25 355�1�oi <br />TENANT NAME CONTACT FOR PERMIT LfZ� �� J���' �� <br />��%�%�/� I���' L/Y� E•MAIL <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />li.ry' �l n/�T� OU>76Cr �- I�TL-• /�G=/�� LS�.�r�r. ��J. LYNn�cuoa� ,�25 775 G�VC�`/ <br />CONTR. LICENSE # na Y�=n� yU��� ��, '� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />/����°� ���=�� <br />�/J $r'� Ir'I c' <br />HEAT SOURCE <br />[leclric � Gas Other <br />CONTRACT PRICE OF WORK <br />�T��U�' <br />�,ris n,�U G!� � Tr� �_��cf r,�/�t �t/ecti G=� 5� ri�N� �� <br />Goc,4�'raN, N�.; ��<��.�� �r�s piPrNcf. <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Showcr <br />Kilchen sink 8 disposal <br />Dishwaslier <br />Clnthes washer <br />Water heater <br />Sink (servicelbar/mop/elc.) <br />Back(low preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Irap <br />Roo( drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A�C – air handling unils <br />Forced air systems <br />Gas piping <br />W aler heater <br />Gas tireplaco <br />Gasrange <br />Cblhes dryer <br />Range hood <br />Exhaust (an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodsiave <br />Other <br />CITY OF EVERETT LOCAL SALES TN( CODE IS 3105 <br />I hereby ceritify thal I have read and examined this application and know the same to be true and correcL All provisions o( laws and <br />ordinaces goveminc� lhis lype of work will be complied wilh whelher specilied herein or not. ihe granting of a permit does not presume <br />lo give authority to violale or cancel ihe provision of any olher slale or �ocal law regulating constructiun or lhe periormance of <br />construction. That I am authorized by the owner o( this property lo per(orm fhe work for which applicafion is made and I comply with the <br />Slale Contractors La�v 18.27 RCW �nd 296.200 WAC. <br />� `�, –' [ C/ (� <br />,��-�1�.7L �–c�:.�-G/ l ���- � �'L' O <br />SignaWre oG wnedConlraclod� h' ed Agenl � Dale <br />