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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.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM 70 4 PM �,� � 8�� <br />SITE ADDRESS I PARCEL TAX I.D. # PERMIT N <br />DIC�I �� �=�rc���.✓,+o,,,. (lii�/� iSZ�1�l i�,�v�%v1�I�1M :,i�;u3 - do lo <br />LEGAL� LOTNO. �_j' BLOCK <br />DESC. I <br />OW NER <br />}�n�i�?on P an� <br />TENANTNAME <br />Wa�hi�� ��{t%��'� <br />(,Lctr� i�1�� �i ��vr�. � 11 C <br />CONTR. UCENSE # �� � ��5� <br />USE OF BUILDING <br />G I, <br />TRACT OR SUBDIVISION / <br />28- U�I- l� -S <br />CONTACTFORPERMIT <br />I V I.SYI f V L��/i f C G <br />�zeti- i�r ��� 71 <br />HEATSOURCE <br />Electric Gas Olher <br />PHONEt.�G,� �-i'.S�'%-�11i,i�L� <br />�ii.,cir rn�ne- � C7n-l. <br />�enrncr� �z� �t��`ir�� <br />��Z�S' <br />CONTRACT PRICE OF WORK <br />t' �O, (�OC� <br />W9 K DESCRIPTION <br />�c:���;�L � c�i�pos� o-F ��-i��n� �� ��,�2� e. i <br />I(1 ��Gl l � ilL6'J `�-s� �1 V1 Gt l� �-,�-�_ Y�r„�n U;,�.� .,�Y' d� �.7 a,� �� <br />�J <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposai <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />N0. I • TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />_ Clothes dryer <br />Range hood <br />Exhaust(an <br />Heatpump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby certiy that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinances goveming this type of work will be complied with whether specified herein or not. The granting of a permil does not presume <br />to give authoriry to violate or cancel the provision of any other stale or local law regulating construction or the pertormance o( <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with ihe <br />State Contractors Law 18.27 RCW and 296200 WAC. <br />Signature o( OwnedContractodAu;honzed Agent Date <br />1/ <br />2 <br />