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���� w PERMIT ARPLICATIOIV <br />, �J���o� �� ��� CITY OF EVERETT PERMIT SERVICES <br />^`�' f�, �� 3200 CEDAR STREET, EVERETT, WA 98201 <br />'J �'' fir' \ 425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />SITE ADDRESS <br />��Z� <br />LEGA LOT N0. <br />DESC. <br />APPLICATIONS ARE ACCEPTED FROM 8 HM TO 4 PM <br />c� I ;� :-2v� ' �� <br />` BLOCK <br />� ����� <br />PARCEL TAX �.D. N <br />Oc�10 z� ccc��� z;cc <br />TRACT OR SUDUIVISION # <br />D - �- c> <br /># <br />�.�;�i:.�� ;������::ti 85z z '1''" ,'1�� S�. lw ��; �Sza`g �2S-3s�� <br />TENANT NANE CONTACT FOR PERMIT PHONE ._ ,� r�� <br />vJG �i"L�'i�'�'-�� <br />C l:l l�-�� I�iCZ��v � .j���UL �>.�' � �. . ��,L ] � G. ��9L <br />e-Ma� � 1' )„• <br />CONTRACTOR ADDRESS CITY/ZIN HO E <br />�iiC,lhC. i�l�-IS�(i�`� VA4{1G12-f'Iti'�fl�,i=� r'.C,��i�X Z��J VU:;(Yii�J�11G �tZ1—`'�23'�'-YSYI.� <br />CONTR. UCENSE # / �\ �7 i C �"L <br />P�� ciF�C, i'��cs�L51i /I /1U�10 ) <br />USE OF BUILDING <br />.., ii�l�-i��Mll,�! i�l`-�i;�.^JC� <br />WORK DESCRIPTION <br />��1��': i1��21: <br />�_!JI I'-�� • <br />HEAT SOURCE � CONTRACT PRICE OF WOAK <br />� Eleciric _ Gas _ Other .#� � j� pOQ <br />.,,��i;�L �� i: 'I+J ,�'I� > >� � c:�N:..(LCT-. <br />I-ti..:r�S•A��I�:N -� '_� V i L�. i`� I...� Ll. L <br />N0. I TYPE OF f1)(TURE OR ITEM <br />I Toilel <br />I Bathtub <br />� Lavatory (wash basin) <br />Shower <br />i Kitchen sink�8-dispesnF <br />J_ <br />� <br />Water <br />Sink (: <br />Urinal <br />Drinking Foun�ain <br />Floor drain <br />Greasetrap <br />Root drains <br />Other <br />NO. I TVPE OF FI%TURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />3s range <br />Clo ttes dryer <br />Exhausl f�cl <br />Neat pump <br />Uni� healer <br />Boiler <br />Relrigeralion <br />Woodstove <br />C�7Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilily that I have read and examined ihis application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type ol work. will be complied wilh whether specitied herein or noL The grantir.g of a permit does not presume <br />to give authority lo violate or cancel the provision ol any other state or local law regulating consiruction or the perlormance of <br />construction. That I am aulhorized by the owner ol this property m perform the work for which application is made and I comply wilh ihe <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />�_ �� � � -'-. �Ci�:����c��i <br />Si9nature of OwnerlContraclor/Authcr�Zed Agent Date � <br />� <br />w �n:+ <br />J <br />� u .`� . <br />