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PERMIT APPLICATION <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 ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />�„�F 9�, c�; �,,= <br />i,. <br />LEGAL LOT N0. BLOCK <br />DESC. �/ <br />i' <br />TENANTNAME <br />I PARCEL TAX I.D. 8 <br />1'. E�C� 6"/4 r�c:;ro�'.3c <br />TRACT <br />/�� , � / �/r,.- <br />ADDRE93 CITY2IP <br />�i...v. .'-!'i/� . <br />CONTACTFORPERMIT <br />'_� �p <br />PERMIT N <br />� (�OS-�5 <br />PHONE <br />, ' ,,�.�_ �" I ,�;'t /�'��.,� �r.�S, �.5'� C.��' <br />.. <br />CONTRACTOR ADDRE83 CITY2IP PHONE <br />CONTR. LICENSE p <br />ia•�'.�-.•l° s�/; 9�yc, <br />USE OF BUIL.DING <br />ti•i Y` ' - <br />/'�' %"� �,r `,E'l <br />HEATSOURCE <br />Eloctdc � 'Gas Other <br />WORK DESCRIPTION � � ���� „_ �� Z <br />�i, 1 r <br />NO. I TYPE OF FIXTURE OR ITEM <br />�_ Toilel <br />� Bathtub <br />— Lavalory (wash b�sin) <br />—T Showor <br />� Ki�chon sink 8 disposal <br />Disliwashar <br />Clolhos washor <br />�� Walor healor <br />Sink (sorvlce/barlmop/elc.) <br />�_ Dackflnw prevonlor <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greaso trap <br />Roof drains <br />Olher <br />�. � ' � <br />' � _S <br />/���,k,%Te.�� �.� /.? ���..�� <br />� CONTRACT PRICE OF WORK <br />N0. I TYPE OF PIXRIRE OR ITEM <br />A/C — afr handling units <br />Forced ai� systems <br />Gas piping <br />N'ater haater <br />Gas (ireplace <br />Gas range <br />Clothos dryer <br />Rangohood <br />Exhausttan <br />Heat pump <br />Unit healer <br />B�Ilor <br />ftelrigeratlon <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS ]705 <br />I hereby coriti(y that i havo read and examinod Ihis applica�ion and know the camo lo be true and corre:t. All provislons ol laws and <br />ordinaces govttrning this lype of work will bo complied a:ilh whother specified heroin or nol. The granting o( a pamiil does nol presume <br />to givo authority fo violate or cancol thr, provision of any olher st:ite or local law regulating conslructior or the peAormance o( <br />conslruclion. That I am authorized by ihe ownor ol Ihia property to poAorm lhe work lor which application is mede and I comply wilh the <br />Stalo Conlractors Law 18.27 RCW and 2�3�.200 WAC. <br />J <br />�� <br />? <br />