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ADDRESS <br />� � 1 �1 <br />L�GA[.� LaT Nd. <br />DESC. f <br />• <br />P�RI�fIT APPLICATI�� <br />CIT�f OF �V��ET'T P�RIIr11T SER1lICE� <br />32Q0 CEDAR STREET, �VER�TT, 1NA 98201 <br />4�25-257�$810 — FAX �25�25i-8857 ^ �nnNw.everettwa_org <br />APPLICA�I�NS AR� ,,ACCEP��D FROM 8 AM TO Q� PM <br />PARC�L ?'AX I_p. # <br />BLOCK I 7f2qCT OR SU6pIV1310N t� <br />T�NANt NAM� <br />NTRACi R ,����� � � �, <br />corrrR. �.ic�rr�s � 1tiu1�0�� <br />�C-2.. <br />tJ9� OF BUli,pfNG <br />ci�rrrz�� <br />��J � • <br />� CONTACT FOR PERMIT <br />� �,i t (� L� 11i'i.$�,�� <br />ADi�RES 'y °�[� �` d , � ��.� <br />��AT SOURCE <br />Electric ,_ Gas � other <br />WORK DESCRfPT�0�1 <br />� � � `1 �V C�\� � � �t�.-� �� �� � �� <br />�ro <br />PLUMBING <br />TYPE pF FIX7UR� OR lTEM <br />Tallet <br />Br�tht�ib <br />Lavatory (�nrash basin) <br />Shower <br />� Kltchen sink & disposAl <br />Dishwasher <br />Clothes washer <br />Wator heater <br />Sink (servicelbar/m�p/etc.) <br />Backflow praventer <br />Urinal <br />Drinking Fauntain <br />FlOof drain <br />Greaso trap <br />Roof drai ns <br />C}ther <br />PERMIT # <br />%i� � a�lU -05� <br />n <br />P�fONE �':d�•�.c^ oi �i �'� �'� Q�.? <br />E-MAII...X*Gt �'Y'l,,a ?.a;�`l����.,A�l..y't_o, <br />YlZIP F'l10N� ��—� <br />��-!�'1-� ��1.� � � �'� ��� <br />� �t�� lG �, <br />CON1'RAGT AF21C� OF Wl7RK <br />��� i 0 <br />,� <br />Na. f TYPE OF FIxTU�RE OR IT�M <br />��c -- alr handling �mits <br />� Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />� Range hood <br />Exhaust fan <br />� Heat pump <br />_ Unit ha��er <br />�., Boilor <br />,,, I�eFrfgeration <br />..` Woods#ove <br />.� Other <br />CITY OF EI/EI��TT LOCAL SA�ES 7AX COD� IS 39U6 <br />� horeby cartlfy that I have read and examined thia application antl know #h@ same to be true and corr�ct_ A�I provisions of laws �nd <br />ortlinancas governing this typ� of work wlll b� complied wi#h whother sppcified herein or not. The grantfng of a�erm;r does not pres�an-,� <br />#o give authority to viola�to or Caneel the provision of any other s4ate or local law regulax;n9 construction or the pE;rtormahce af <br />�a1,ecomyt ction, 7hat 1 am authoriz d by #he owner of this property ta p��{orm Yhe work for which applic�tion is macte and I comply with the <br />ontractors �aw ��,27 and 296. 00 WqC. <br />� 0 �- `'� <br />a�ufe of wner/Cnnrr�rr rin,� A..,.:__� ,. _ . � 1 l <br />�� <br />r� , <br />