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PER�VIIT APPLICATION <br />CIT`l O� EVERETT PERMIT SERVICES <br />320D CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />y�9-a� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO ^. PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS ��,_ ��� �� ���is�m titrrrl <br />LEGAL LOTNO. BLOCK <br />DESC. <br />OWNER <br />tiuurisc \'iru� lir�irr�ucnt \'ill�i <br />PARCEL TAX I.D. # <br />00 i I; i I11:{(ill:i I UII <br />I TRACT <br />P�risc src Sliccl :1-`1 ollhe cucluscd pl�ws. <br />ADDRESS CINIZIP PHONE <br />$i`10 \lmli>on Sllrt9 I•:t'crcll� \1'.1 9$211;i (1`d-il :t:i'5-111111 <br />TEIJANT NAME CONTACT FOR PERMIT PHONE <br />\'rriruu \\'ircl�•s, Re:dCum As�ur. -.�ruuili�r'I:i}iur 1'l:i'?i�l-I ! I I cv. I I I <br />I I I:4Y 51: 4:ulGatc 1\;ic Suilc Ylill licllc�vc. \1':\ !IROUi <br />CONTRACTOR .�.'S�� ADDRESS CITY2IP PHONE <br />CONTR.LICF.NSE# <br />USE OF BUILDING <br />('� muucrei�il!rei�iil <br />WDRI< DESCRIPTION <br />— HEAT SOURCE I CONTRACT PRICE OF WORK <br />N/�A S!I,III IO.UII <br />Electric _ Gas _ Other <br />\'crii.ou \1'ircicss pruposcs �o rcplac•c si� ((i) cxisliuq �udcnua� ��•ill� six ((i) uc�v p:mcl anlcuuas lu bc :Ulanc�d <br />�o �hc samc mueiws uu �hc cxisliny muuupulc lu�•:Ucd a� 2i20 \fad�°vu tilrccl I?�rrcu. \1'asl�iu�,hun (A.P.\. <br />1111.51i1113(i0;i100). Plca,c xcc ihc curlu,cd Yrqjcri 1)cscripiiou li,r murc dcCiilcd iufunn:uiou. <br />N0. � TYPE OF FIXTURE OR ITEM <br />Bathtub <br />Lavalory (wash basin} <br />Shower <br />Kitchen �ink 8 disposal <br />Dishwas�ier <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Flcor drain <br />Graase trap <br />Roof drains <br />Other <br />RC.71 <br />NPE OF FIXTURE OR ITEM <br />A/C — air handCng units <br />Forced air systems <br />Gas niping <br />We heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeratinn <br />Woodstove <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby ceritiy that I have read and examined this application and know the same to be true and wrrect. 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 give authority ro vioiate or cancel the provision of any other state or local law regulating construction or the performance of <br />constr clion. That I am authorized by the owner of this property to perform the work for which applicalion is macle and ! comply with the <br />Stat ontractors L 1827 RCW and 296.200 WAC. <br />`� �., ��a l0� <br />Ig ure of Ow ntra uthorized Agent Date �/� <br />