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���ERI�JIIT APPLICAI �ON <br />CITY OF EVERETT PERMIT SERVICE� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8Q 10 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS / <br />'l'�l / � l 7 �� L <br />LEGAL LOT N0. <br />DESC. <br />BIOCK <br />OWNtK U�' 1 �� Ly�L <br />✓I�Vi.�'� .Qi�L�I/Y�� ��% l � <br />TENANT NA�AE <br />S �:.: � <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />11V_4. � f%/.�7�.�'s� <br />WORK <br />PTION • <br />` J ,���/%�r.���� <br />� <br />NO. I TYPE OF FIXTURE OR ITEM <br />V Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />� Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor �Jrain <br />Grease trap <br />Roof drains <br />Olher <br />PARCEL TAX I.D. # <br />TRACT <br />ADDRESS <br />� �� P� �� ��, <br />CONTACT FOR PERMIT <br />HEATSOURCE <br />Eleclric �as Other <br />��%�.(' L'C� <br />NO. <br />PERMIT # <br />2_ <br />�tr,�5� `�--G�s� <br />PHONE <br />l� ( <<�-r) �l� �-' �0 ird'- <br />CITY2IP PHONE /� <br />C_ � �1�,$) ��1� ' /!�- (J <br />CONTRACT PRICE OF WORK <br />CAL <br />TYPE OF FIXTURE OR ITEtd <br />A/C — air handling units I <br />Forced air systems �i �d iq,..f' dU� �f �n �' ,,/ <br />Gas piping hBnF iba /vrU�� �Ec'�( <br />Water heater <br />Gas �replace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Waodstove <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br />I hereby ceriti(y that I have read and examined lhis application and know the same to be true ar.d correcL .411 provisions of laws and <br />ordinaces govemir.g this rype of work ivill be complied with whether specified herein or noL 7he granting of a permit does not presume <br />to give authonty ro violate or cancel the provision of any other state or local law regu;ating consWction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Stale Contractors Law 1827 RCW and 29fi200 WAC. <br />�"/ <br />�L <br />