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Pff.tMlT APPLICATIO► <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 —www.averetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRE55 �(�i� 1�„�,,,,, � p <br />���L �1►UIVTV <br />LOTNO. /�, A I BLOCK I TRACT <br />L �k <br />TENANT NAME <br />PARCEL TAX I.D. N <br />�/C�E'f/D2 <br />�CONTACT FOR PERMIT PHONE <br />�r�tt-�ela f/a�h� �.�s-?s <br />CONTRACTOR L . IIm �� ,/ ,Ie , ,�r��RE8S " CITYRIP ' /� N�� <br />.CJL(' i�" ry -� 7' <br />CONTR.UCENRc� /h71LIL�i1�fQ.[J v ��% ! �*' ,l/G /� ��L"�1�L� <br />USE OF BUILDINO <br />WORK D SC� .RIPTION � � <br />�L�lJLe'i � <br />N0. � TYPE OF FI%TURE OR ITEM <br />� Toilet <br />Belhtub <br />Lavatory (wcah besin) <br />/ Shower <br />� Kitchen sink 8 disposel <br />� Di�hwesher <br />�_(__ Clothes wesher <br />__ Laundrytray <br />_ Sink(servicePoedmopletc) <br />BeckAow preventer <br />V Urinel <br />^ Drinking Fountein <br />Floor drain <br />Grease trep <br />Rool dreins <br />Other <br />/ J'" %Q <br />�A— <br />— HEAT SOURCE I CONTRACT PRICE OF WORK <br />Elecinc ✓C�as Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC –alr hendling unils <br />l�forced elr syslems <br />Gas pping <br />L, Water heater <br />1 Ges lireplece <br />L Gas range <br />1 Clothas dryer <br />_ Range hood <br />�� Exheust len <br />- �__ Heel pump <br />Unl; haeler <br />' Boller <br />Refrigeretion <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL 9ALE8 TA% COUE 19 7106 <br />I hereby centify ihet I have read and exeminad Ihis epplication end know the same lo be lrue end cortect. All provlsions o( laws end <br />ordineces goveming ihis type ol wark will be complied with whether apedfled hereln or not. The prenling o1 e pertnR doea not presume <br />to give euthority to violate or cencel the provislon of eny olher stete or local law teguletlng construdion ot the performance of ��h the <br />wnstruction. T��et I em authorized by the owner of ihis propeAy to perlorm the work lor which epplication la mede end I comply <br />Stete Contradors Lew 18.27 RCW end 296.200 WAC. <br />�/�� i <br />il <br />� <br />.� <br />