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PERIVIIT 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 HM <br />SITE ADDRESS <br />��:'<_ � Z_'1" St . <br />LEGAI LOTNO. BLOCK <br />11F.5�' <br />TRACi <br />PARCEL TAX I.D. M <br />�RMIT p <br />7C�5 - �� <br />� � II _ <br />�t�! 'I��� .� i111V L�!':�ir'n :��Q[; �� � S 1 .5��.� VC.%i:.� if�.�r�.� r�� '3� <br />TENANTNAME � \ CONTACTFORPERMIT PHONE <br />� I <br />/V �A tl (,ti�A �rtii�l'- �l�Y'- b E 2- 5 3 i�- <br />CONTRACTORC� -,jP��t,t. (����Iync(r:e AUDRESS�j�, �;. 'j75i CITY2IP PNONE <br />CONTR. LICENSE 1 • S = rk�..� � � � � 4�O � 'e �� 1 � `� � <br />!��f-5-j�._�l`a`i�� �. <br />USE OF BUILDING <br />.. � . ,i � t- • • -- <br />I WORKDESCRIPTION �- �1 I � <br />� <br />I <br />I PLUMBING <br />NO� TYI E OF FIXTURE OR ITEN <br />Toilet <br />6Pllilub <br />... �, I.avalory �wash basinl <br />Showrr <br />Kitchen s�nk R uisposal <br />Dishwasher <br />Gothes v.�35hp, <br />�---" Laundrv'ray <br />Suik �srrv�cc�' mmap�elc 1 <br />pachllow precenter <br />Unnal <br />Drinking FOunlain <br />Floor d�ain <br />Grease trap <br />Roof A um <br />Other <br />HEATSOURCE <br />_ Electnc _ Gas _ Olhei <br />� � f <br />i )., ...<< � . I��. �� , �� <br />,�' � <br />N0. <br />CONTRACT PRICE OF WORK <br />Niv;�H3 c.-- <br />i I C�\ I Y\ ( <br />�.� <br />TYPE OF FI%TURE OR ITEM <br />AIC - au hondhng ��nils <br />Forced au systems <br />Gas pipmg <br />Water heater <br />Gas Greplace <br />Gas range <br />Clolhes drver <br />Range hood <br />EHhaus� lan <br />Heat pump <br />Unit heater <br />Boaer <br />Retriocrahon <br />Waods�ove <br />Olher <br />CITY OF EVERET�! I.00AL SALES TA% CODE IS �105 <br />I I�,ereby cenldy ihat I have read anA eranuned Ih�s appl�r,nion and know the same to be tme and correct All o�ovisions ot laws and <br />o�dmaces govem�ng Ihis type o1 work w�u br rnnq�i�od wdh whether speafied herein or not fhe granUng ol a permit does not presume <br />to qrve authouly !o violate or cancel Ihe �nov�cion ut any other slate or local law regulating conslrur,hon or the performance ol <br />rnnsVuction That I am aulhon7eA by Ihe ownei ot this property to pedorm Ihe wo�6 for which application is mvde arid I comply wdh the <br />titate Contractnrs Law IA 7i RCW and 296 7n0 WAC <br />—��i <br />_'�i 1 /!� <br />�Si9nalwe ol Owne racloriAuthnn,-ed Agent � Dale <br />L'S �� 11ty� <br />