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__ _ _ _ _ � ----- -- - --- -- � -- <br />PERMI�' APPL.ICATI(�N <br />I CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />I 425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS P:RE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS L'�S'��'..: !'� PA12CEL TAX I.D. # <br />��?'��I I��-� Av� vJ� �y '�,oG��x�/ o 00 <br />LEGA'�_ LOTNO. ,��BL�CK TRACT � <br />i DESC� ....,+�� .- ,)� In�� C jQ%�el'1 <br />� OWNF.R ADORESS � CIN/ZIP <br />i�-.e��.c�allome5 n1�.�1\�nC. � ��bl�D•S.U� S�eveng L.kt•Skevens <br />"�4.-s�2II2_ 48�5�5 <br />ITENAt1T NAME <br />,'1 :� <br />CONTRACTOR <br />CG4TR. LICENSE ri <br />USE OF 9UILDING <br />—�'--'�-- <br />WORK DESCRIPTION <br />�0'l�`6 <br />SFR <br />NO. I TYPE OF FIXTUR� OR ITEM <br />Toilet <br />Balhtub <br />Lavalory (wash basin) <br />Showe� <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mopletc.) <br />Backflow preventer <br />Urinal <br />Dnnking Foun;ain <br />Floor drain <br />Greasetrap <br />Roof drains <br />Other <br />CONTACT FOR PERMIT <br />EC�\Yl \-t��Ci � <br />ADORES9'' <br />� <br />/'���,�� �<<:( <br />; � '�� <br />% "- , <br />� <br />HEATSOURCE <br />_ Electric „1} Gas _ Other <br />)NE V2S ' <br />��0573 <br />)NE <br />2�' �� <br />�.��y � OS'�]: �i � t <br />CITY/ZIP PHONE <br />� 'r t . r <br />.�'•. �', . <br />CONTRACT PRICE OF WORK <br />: Cv'� I� �,�� <br />NO. TYPE OF FIXTURE OR ITEM <br />A/C – air handling units <br />1 Forced air syslems <br />� Gas piping <br />_L Water healer <br />� Gas freplace <br />_j_ Gasrange <br />� Clothes dryer <br />�_ Range hood <br />� Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CIN OF EVERETT LOCAL SALES TA% COOE IS 1705 <br />I he�eby ceriti(y lhat I have read and examinetl this application and know lhe same lo be true and correct All provisions of laws anC <br />ordinaces governing this type of work wdl be complied with whelher specifed herein or noL The granting of a permit does not presume <br />to give aulhonty to violale or cancel the provision of any other slate or local law regulating construction or the performance of <br />construction. That I am authorized by the owner cf this property to perfo.'m ihe work for which applicatinn is made and I comply with lhe <br />Sta�e Contracl s Law &�7 RCW a d 296200 WAC. <br />� n � ! cti i� �i� ��IG� �iD <br />Signa�ure of wner/ ntractor/Authonzed Agent Date I� <br />l� <br />