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P�r�MIT APPLICATIGrI <br />CITY OF EVERETT PERMIT S�'RVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIY CARDS ARE NOT ACCEPTED <br />SITE ADDRESS�.>-�7 <br />- /Sr'' A✓e kJ <br />LEGAL LOT NQ. B 1 <br />DC-SC. <br />OWNER <br />,q �vlJ _ 1c,4 � <br />TENANTNAME <br />CONTRACTOR L/J� � �j/C'fjZ�lL� <br />CONTR. LICENSE # � �� <br />� �y�, ; <br />'��� !'; <br />.,_. �r ,ti�. <br />USE OF BUILDING <br />WORK DESCRIPTIO'J <br />Cansfi� �t-�� <br />,L�� <br />�_ <br />PARCEL TAX I.D. it <br />iRACT <br /># <br />�d /3dk IoSZ �'}tuk�%f�a� !N� %�'L%S <br />CONTACT FOR PERMIT <br />ADDRESS � � <br />�'✓'�/ f�� /, /�e <br />�7�fe?.�Sci�'//l ��% <br />o� /S09 <br />LING <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sin', ��arvice/bar/mop/etc.) <br />Ba� •�ilow prevenler <br />Urinal <br />Drinking FouNain <br />Floor drain <br />Grease lrap <br />Roof drairis <br />Other <br />HEATSOURCE <br />CITY/ZIP <br />Eleciric � Gas _ Other <br />Sg. �'� SI.�y� <br />� <br />PHONE <br />Z� � —Gv�� �r��/ <br />PHONE <br />U: � �� �%�� <br />���� <br />' PRIGE OF WORK <br />-(�.,r�y r�z�� <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas (ireplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Waodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined lhis application and know the same lo be lrue and correct. .411 provisions of laws and <br />ordinaces goveming Ihis type o( work will be complied with whelher speci(ied herein or noL The granling of a permil does not presume <br />to give aulhority lo violate or cancel the provision of any other slate or local law regulating construction or lhe performance of <br />conslruction. Tnal I am auihorized by the owner o( this property to perform the work for which application is made and I comply with lhe <br />State Conlr�tofs Lawj$.27 P.CW and 296.200 WAC. <br />� l4zF� ��2a9 '�z <br />/� I <br />