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PERII�IT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-A857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE P.DDRESS PARCEL TAX I.D. # PERMIT # <br />-' (� C'i heC.�"v- e I� r r r� �/L I�� G� C <br />LEGAL� LOT NO. BLOCK TRACT OR SUBDIVISION p <br />DESC. <br />OWNER ADDRESS CITY2IP PHONE <br />Vzl'lu�l �.L6y '�1'ec-���'erh�e �veve�' <br />TENANTNAME � CONTACTFORPERMIT PHONE <br />CONTRACTOR f� ��Y(Ci Y� _ ��(. <br />CONTR. LICENSE t! <br />USE OF BUILDING <br />��,�tti,c�le ����,�,�y�e,,•� <br />WORK DESCRIPTION ' <br />�--� a � �-�y <br />i`���1, ,:tr: <br />NO. <br />J+t u e L, tw �•-. <br />ADDRESS <br />'� �� 13�x Ws�� <br />HEATSOURCE <br />� Electric _ Gas _ Other <br />CITY2IP <br />Mi: ��,t�.i ��C <br />,. �.. �- <br />��;�,�-7U <br />ad" 7sY -��. <br />� <br />PHONE <br />yzs 7 s�,� 9�SY <br />CUNTRACT PRICE OF WORK <br />/�� dZ� <br />� 5�riu�� c�aN\{��� IST-Y�oo�� f-3-r{'tr�� F�.a���'1 <br />� <br />� (,�c,�.a.� .-��--,� �jc�s e ►Me..t ��erY t �:,ir` <br />;� <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Waler healer <br />Sink (service/badmop/etc.) <br />BacAflow prevenlrr <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systr,ms <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />h2ange hood <br />� Exhaustfan <br />Heat pump <br />Unil heater <br />Boiler <br />_ Refrigeration <br />Woodslove <br />Other �Z✓�Si cr� <br />— < � . �tw c �'iC <br />— �3.['�4' lN<✓tT <br />CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br />I hereby ceritify thal I have read and examined this 2pplication and ;<nc�v the same to be true a�d correcL All provisions of laws and <br />ordinaces governing this lype of work will be complied with whether speci(ied herein or noL The granting o( a permit does not presume <br />to c�ive authority lo violate or cancel lhe provision o( any nlh=.r state or local law regulating consWction or lhe performance of <br />conslruclion. Thal I am authorized by the owner of lhis pro����rty to perform the work for which applicalion is made and I comply with the <br />State Cbqtractors Law 1827 RCW and 296.200 WAC. , <br />J ���.��0 <br />