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PERMIT APPLICA�'ION <br />CITY OF EVERETT PERMIT SERVICE:i <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />SITE ADDRESS <br />1�� . ��'��.�, r�� � <br />LEGAL LOT NO. <br />DESC. I �� <br />OK'NER <br />LectG��.0 1iUYv1e5 NW <br />TEN T tJA E <br />� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />I PARCEL TAX I.D. # <br />BLOCK <br />CONTRACTOR , <br />� � � • i,.,� .. <br />CONTRILICENSER'� '� �� ' <br />/ f_r A�Iln�7�0 <br />USE OF BUILDING <br />WORK DESCRIPTION <br />TRACT <br />HUUI{CJJ <br />�$�(o5•�lz•S�e�ev�5 �• <br />�ZOC� <br />CONTACT FOR PERMIT <br />t • <br />AODRESS <br />I <br />11 / i_/ l. <br />� � , -t:F-• �. <br />NO. I TYPE OF FI%TURE QR ITEM <br />T otlet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen �ink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />•r ���n •L,r� __i. <br />��E� -- <br />CITYIZIP <br />L-}z •Sie.� e i�s <br />9 �26�__ <br />HEATSOURCE <br />_ Electric _yGas _ Uther <br />NO. <br />PHONE <br />CIN21P PHONE <br />� . � • • <br />I CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />NC — air handling unils <br />Forced air systems <br />Gds piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstov., <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritiy that I have read and examined this application and know the same to be true and cortece All provisions of lav.�s and <br />ordinaces goveming this rype of work will be complied with whether specified herein or not. The granEng of a permit does not presume <br />to give aulhority t� violate or cancel the provision of any other state or local law regulating consWction or the performance of <br />construction. That I am authorized by the owner of this property to pertorm lhe work for which applicalion is made and I comply with the <br />State ConUactors Law 1827-RClNand 29 .200 WAC. <br />� <br />/ �� .���fl�-�- �� �� : � r- <br />