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�� � <br />�ERMIT APPLICATION <br />� CITY OF EVERETT PERMIT SERVICES <br />S 3200 CEDAR STREET, EVERETT, WA 98201 <br />�� 425-257-8810 - FAX 425-257-8357 - www.everettwa.org <br />APPLICATIONS ARE ACCEPT[D FROM 8 AM TO 4 PM <br />SITE ADDRESS �'� �k � ' •� "",—' <br />Uv I -l��"` I��� <br />LEGA LOTNO. BLOCK <br />DESC. <br />OWNER <br />Cl i� oC '_�� �021. i � <br />TENANTNAME <br />CONTRACTOR ,/� <br />�L,S:o.� I'��ti��-T:� <br />CONTR. LICENSE # <br />�L`�1c�t-".2IZ�C., <br />PARCEL TAX I.D. # <br />TRACT <br />��RMIT # <br />�.�� S'�d <br />ADDRESS CITY2IP PHONE V 2 �'- Z� '! - <br />/ ' � � � � � <br />��.o� �G-.�!'rti.�i CVC-2C-��.WI'k`��'��ol <br />CONTACT FOR PERMIT <br />I�2LN i j2� itM <br />� G, .S iA `�,RESS� ' � D-�� <br />USE OF 3UILDING <br />F�i rZ� S �.� ,—,��� <br />WORK DESCRIPTION <br />1�-�:��`.� �,,... <br />HEATSOURCE <br />�2 S 3� <br />CiTY21P <br />KE... .-, c�,� <br />Gti�z,.,zl <br />Eleclric _ Gas _ Other <br />" PHONE <br />8; /. �'T7� <br />PHONE <br />Z7 3-'cS�F' <br />o �., z. � T a <br />CONTRACT PRICE OF WORK <br />.�� � �, S `-t� J c, <br />N L c�c-.._w. r��., Vc-.-., ��c_ c—x�cr���� r s•�s � c�., <br />(..� I 1�4 �. �-' i7 `-' c._ �� o. �. ;'� F�'.� <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balh�ub <br />Lavalory (wash basin) <br />Shower <br />K�lchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />W ater healer <br />Sink (service/bar/mop/elc.) <br />Back(low preventer <br />Urinal <br />Drinking Fountain <br />Floor drein <br />Grease irap <br />_ Roof drains <br />Olher <br />� <br />NO. � TYPE OF FIXTI�RE OR ITEM <br />A/G — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaust (an <br />Heal pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodsl�ov,e <br />C other VL �-t�� �� C� �+.�n�•� ; <br />5•rs �c,� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y thal I have read and examined lhis application and know lhe same lo be true and correct All provisions of laws and <br />ordinaces goveming ihis rype ot work wiV � e complied wilh whether specified herein or not The granting of a permil does not presume <br />to give aulhorily lo violale or cancel the prr�vision of any other slate or local law regulaling construction or lhe pertormance of <br />conslruclion. That I am aulhorized by lhe owrer of lhis property lo pertorm lhe work for which application is made and I comply wilh lhe <br />Slate Conlractors Law 18.27 RCW and 296.200 WAC. <br />/ <br />SignaWre of OwnedContraclor/Authorized Agent Dale <br />