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P�RMIT APPLICATIC�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wviw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />/ ' `' ` <br />� : ` Sr_ <br />LEGAL LOTNO. BLOCK <br />DESC. <br />OWNER <br />f�c7.vr��� ll oy� � <br />TENANTNAME � <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />io ti� z S�h D� s <br />CONTACTFOR PERMIT <br />lo� `/ _' '""mm � <br />/� HUUItC: <br />�vl�" �� /_fG.'� �I�� <br />CONTR. LICENSE #����f �i �� 1 q� �� Li <br />��- 1 Y l <br />USE OF BIIILDING <br />�s�� ��i ��, � <br />WORK DESCRIPTION (�L�P/G��, <br />I <br />��'I,����r� G.,�,� ��F <br />�2 <br />�� -�D <br />�crz {� 9$za � y�s 3ss �b <br />PHONE yZ S" .�l � %SS � <br />E-MAIL % ,.. �. ,d /,-��✓�C �I�K['S- <br />{�o✓yfl//��C � �! %[7 <br />HEATSOURCE <br />Eleclric _ Gas _ Olher <br />l� <br />y� s fc � �ss � <br />CONTP..4CT PRICE OF WORK <br />�Ct i�v�� , %c-rnf� c�C� CC+rN�J �Ct��i� <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Baihlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Cblhes washer <br />Waler heater <br />Sink (servicelbar/mop/etc.) <br />Backfluw preveNer <br />_� Urin21 <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof diains <br />Other <br />5 �oo �. <br />�Y �7C iCCp i <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C - air handlinc� units <br />Forced air syslems <br />Gas piping <br />Water healer <br />Gas tireplace <br />Gasrange <br />Clclhes dryer <br />Range hood <br />Exhaust (an <br />Heal pump <br />Unit heater <br />Boiler <br />Re(rigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined lhis applicalion and know the same lo be lrue and correcL All provisions of laws and <br />or.:'naces yoverning this rype o( work will be complied with whelher specified herein or noL The granting of a permit does nol presume <br />to givc aulhority to violale or cancel lhe provision of any other slale or local law regulalinq conslruclion or the performance o( <br />construcliun. Th�t I aM aulhorized b he owner o( this property to per(orm the work for which application is made and I comply wilh lhe <br />State Contractc�rs L� 18.27 RCW id 29G.200lVAC. <br />; i ' /� �� 'S �� � ��� <br />