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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 ✓ �/J <br />425-257-8810 - FAX 425-257-8857 - www.evereltuva.org � �� - ,�-� / <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DE81T 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />/5DZ SF <br />LEGAL LOTNO. <br />DESC. <br />OWNER <br />�E'a�i.a-t�� <br />TENANTNAME <br />BLOCK <br />CONTRACTOR � <br />,�'bN-T�crt �GF�►-I��c <br />CONTR.LICENSE• Sl�./��/ p/16 <br />/V �. ! L�Z�� <br />USE OF BUILDING <br />(2�-`r� i L S�L�s <br />WORKDESCRIPTION ���.lE <br />.� ►u.sr� �r ` r�t.K Y s ' <br />� ��v� c_E C/.l�N�� .t� <br />TRACT <br />PARCEL TAX I.D. # <br />FOR PERMIT <br />t <br />-{ A! L�i(t,(4F�-( p-l�� � 3 7J G-cvaJ7 <br />ADDRESS CRYIZIP PHONE <br />3 3 7S�i �j�'fi� .�' F�+�tL tv�a%'� <br />HEATSOURCE <br />_ Eladric _ Gas _ Olher <br />CONTRACT PRICE OF WORK <br />�5� �.d <br />6l���sTi'�.lE��TFfE I�o�! �5�6N.�� <br />S i<aIJ�UF-�- � Go,vn(F� to �x(STir/�j <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink R disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (servicelbar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />other <br />NO. I TYPE OF FI%NRE OR REM <br />AIC — air hantlling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />_ Heat pump <br />Unil heater <br />Boiler <br />RafrigeraUon <br />Woodstove <br />Other <br />r �Lf+n« <br />CRV OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby ceritify lhat I have read and examined this application and know the same to 6e true and correct. Atl provisans of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting ot a pertnil does not presume <br />to give authority to violale or cancel the pravision ot any other state or local law reguiating construc�ion or the parfortnance of <br />construction. at I am autltorized by the owner o( this propeAy to perfortn the work for whidi application is made and I comply with the <br />Stale Canl Gors Law 18.27 I�W and 296.200 WAC. <br />�/ <br />