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1 <br />� <br />t <br />PEI�iIAIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 GEDAR STREET, EV[RETT, WA 98201 <br />425 25i-8810 - FAX 425-257-8857 - www.everetiwa.org <br />APPLICATION3 ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADURESS � VARCEL TAX I.D. p <br />,I , , <br />� � i,, <br />l FGA LOT h0. BLOCK TRACT Ofl SUBDIVISION 1 <br />D[SC. ' 1 �' ' . � : � � . . '� , � . . <br />� � ' � , (1'!}�;r`1 ! �' I) � <br />' � r' , , ' i . r' i � ' 1 � � ' I.. ' � � ' .. . <br />TENIINT NAME � CONiACT FOR PERMIT PHONE �� . �� i�� l�+'� <br />I . , ., � . � E-MAIL � �.� � ""_ <br />ifTSATR7�TdA-� � , ., . �', � � . , � ' � <br />k� � � ., � .,, u , . . ' � �r� � <br />CONTR. UCENSE N � <br />\ �' ��•';� � � � i ".-��� � <br />USE OF BUILDING <br />� �1t ��.�1��� <br />f <br />---J� ��. th,i�,—. <br />WOFK DESCRIP110N <br />�r 1. .� 14� 1 I n4 i�, <br />- HEAT SOUHCE I CONTRACT PRICE OF WORK <br />Eleclric Gas Other <br />I ,�. I" �, I� I. � , 1 I� ,., , <br />� �, 'i <br />/10 I TYPE Of fIX7UflE Ofi ITEM <br />Toilnt <br />Bathlub <br />Lflva�ory �wash basirQ <br />Sl�owor <br />Kitchen sinh 8 disF�sal <br />Dishwosh,� <br />Clothos � iashar <br />Wator h� �ater <br />�' Sink (sei �ice/bedmnp/nlc.� <br />Aackllow � vevealei <br />Urinal <br />Dnnkinp Foun�ae� <br />Floor drt�in <br />Grease Vap <br />Rool drains <br />O;hor <br />NO. I TYPE OF FIXTURE OR ITEM <br />A�'C - air harnlhng umis <br />Forced au syslems <br />Gas piping <br />W alf�r healer <br />Gas �ireplace <br />Gas range <br />Clothos dryer <br />Rangehood <br />f xhauSl fen <br />Hoat pump <br />Unit heater <br />E3oiler <br />RefrigeraUon <br />Woodslove <br />Olhe�-- --- _--. <br />CITY OF EVEAETT IOCAL SALES TAX COf1E IS 3105 <br />I hereby ceritily that I heve road a��d examinod Ihis applicalion and kiww ihe same to be irue and correcL All provisions of laws and <br />ordmar,es gov�rning Ihis ty{m ol work will be complied wilh whethor specilied herein or nol. The grenling of a pnrmit does nol presume <br />lo gwe eulhorily to violale or cancel itie provision uf any other state or local law reguleting consiruction or the pertormana+ oi <br />construclion. Thal I am authorized by Ihe owner ol ihis proparty Io perlorm the work for which epplicalion is made antl I comply wilh ihe <br />State Coniraclors Law 1827 RCW and 29F>.200 WAC. <br />' r. <br />ignalure o �ed oniredor/ ulhoriz gen� —�ate <br />� , <br />