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F 'A <br />Ft`RMIT A,PPLICATI�N <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 ACr�PTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCFPTED <br />SITE ADDRESS <br />?jJj-5 ��` �-1 EVc �� <br />LEGAL LOTNO. BLOCK <br />DESC. <br />OWNER <br />�� l V� 1 <br />TENANT N E ��— <br />�12`Lt( ��L�.iSL �`�)�ri:S(� <br />CONTRACTOR � n � <br />Iv <br />CONTR. LICENSE # <br />USE OF BUILDING <br />C71��'z'`� C � <br />PARCEL TAX I.D. # <br />TRACT <br />CONTACT FOR PERMIT <br />CLl�� 1�\L�C•i�'�'1 <br />ADDRESS <br />HEATSOURCE <br />Electric _ Gas _ Other <br />I.�SU(o �5 <br />CITY2IP PHONE <br />� . �I `��s� � Z. .l�l—� 12 <br />PHONE <br />�.�a� as9 �i � <br />CITYIZIP PHONE <br />I CONTRACT PRICE OF WORK <br />WORKDESCRIPTION w �� 1 C�,�11Z�,�.� G���,�,� �r� L�-�-(�, 1��U��� �11��{-; c� ��Y�c"�"\o�,'1��� <br />rc�c�ci�-r I�o«�ol ��F-1-, ii�1-r> c�roa��c.i p,-. �111 �Fou� I��jS ��z� <br />r�a.lL-e P��w�.v�v�-( -Fi+y.uc� tr� '�t;�lrec•.ct.� �u_v�asco.pec��.Ar�v,. <br />1�;,,�.�. <br />r <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & dispasal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grease Uap <br />Roof 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 />VJater healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />F;efrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby ceritify Ciat I have read and examined this application an7 know the same lo be true and correct. All provisions of laws and <br />ordinaces c�oveming lhis type of work will be complied wilh wheth.r specified herein or not The granting of a permil does not presume <br />to give authority lo violale or cancel lhe provisicn of any other s��te or local �aw regulaling construction or the performance of <br />constr;iction. That I am aulhorized by the owner of this property to pedorm :he work for which applicalion i� made and { comply K�ith lhe <br />St�PQ Contractors Law 1R.27 RCW and 29&.200 WAC. <br />'12 <br />