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PERMIT APPLICATION � <br />CITY OF EVERETT PERMIT SERVICES //�2 <br />3200 CEDAR STREET, EVERETT, WA 98201 nI ,1 �' <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org �� �J <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # <br />'I�/ 2i �v�r ��'��>_�t L"�c3� `Nu4r3-cv3•o�/°7- OU <br />LEGA LOTNO. BLOCK TRACT / <br />DESC. _ — --� S'rL � �.? c� � C� <br />OWNER / AODRESS ^ CITYIZII <br />I�CY'/�Z...y.l ,(�3/)� �S�G� Ca�i"NL✓3II /lVa:. �3i?�/v <br />TENANT NAME <br />�i)LN� 4 i OLII{'I i/ <br />CONTRACTOR�- <br />/ i5Li.1.�� :l.,c� �.if� { <br />CONTR.LICENSE# FisNES �E �L, <br />USE OF BUILDING <br />)� ` <br />/..�h/ O�/Gc,: <br /># <br />�., 36o-7S�- ZSE� <br />C�ONTAC/i� FOR PERMIT PHONE <br />�G,c-/73vc� �GYC�SG��� ��.A '3(�-�s%-s�%Z <br />� ADDRESS CITYIZIP PHONE <br />r <br />�o�E� s F;S��� G�.,G �3�..%„� f�>�,, G✓,4 ���� 3�� <br />3G,0 - 75�7 - <br />HEATSOURCE <br />LC Electric �i Gas _ Other <br />WORK DESCRIPTION -� <br />� / /�,oy�3 h.-��.��� /��;,,E <br />Tc? ✓ ('��lr". �Z c"'� � /j 7.: : fC 3 /`� �Jo «K. �- <br />�, i.�_� ���� ., f ,���%�„�,-,� �1-r.��> r� <br />N0. I 'fYPE OF FIXTURE OR ITEM <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicefoarlmop/etc.) <br />Backflow preventar <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WORK <br />��3�z�cr� <br />t V ��i G � �LW. ��d/'�-r� <br />i+�fC'v.�.c� 5�/o!'ivr �ucyci <br />/ / '� <br />r%c, ��L� cr�, i� cy7c7 ;' �'.3.^fr <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas firepiace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritity that I have read and examined this application and know the same lo be lrue and cortect. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to giv� authority to vio le or cancel lhe provision of any other stale or Iocal law regulating construction or the perfortnance of <br />const uction, That I a nuthorized by the owner of this property lo perfortn the work for which application is made and I compiy with lhe <br />State �Coctracfors Law 18.27 RGW and 296.200 WHC. ' ' <br />I /1 I // <br />�W <br />'/a <br />