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� <br />� <br />PERMIT APPLICATl�N <br />CITY OF EVERETT PERMIT �ER�'lCES <br />3200 CEDAR STREET, EVERETT, WE� 98201 <br />425257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />1(, � , [i�.� � �� L <br />LEGA LOT N0. BLOCK <br />DFSC. <br />OWNER <br />(� I vnon-�e I-iej� <br />TENANT NAME <br />CONTRACTOR U„ �;n,, .�. ��T <br />CONTtt. UCENSE � �JNLSM MT 72 <br />�I�"> <br />USE OF BUILDING <br />✓'[ S i c'�r v� �i A I <br />PARCEL TAX I.D. N <br />TRACT <br />PERMIT t <br />C c;� 7d <br />-/Y70 <br />> L LL 9His ti f� ��t n�F �tioa L�,� sfP�dH�� <br />CONTACT FOR PERMIT pMONE <br />l�e,-e�-, i'Ylc%�1�e��vt 36o�Gs7-al8o� <br />/ ADDRE88 '�—' - CI7YlLF PHONE 7�,0- 6S 7-o1/E4a <br />Po (�>X 1 �157 r�'1a�ys N ll�e w�i� 9Ba� o <br />— HEAT SOURCE I CONTRACT PRICE OF WORK <br />Eledric Gas ✓Olhet � % gO ��� <br />WORK DESCRIPTION �• ��.I� r s 6�e..� <br />i��5�ti II u iior � oJioma C. 'Fi.-< SP� �•� y <br />NO. I TYPE OF FIXTURE OR ITEM <br />Tollet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />_ Clotl�es washer <br />Laundry Iray <br />Sink (servicelbar/mop/etc.) <br />BackAow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />_ Grease irap <br />_ Rool drains <br />i Other <br />NO. I TYPE OF FIX7URE OR ITEM <br />wc - atr nandung units <br />Forced air systems <br />Gas piping <br />Waler hea�ei <br />Gas � replace <br />Gas range <br />Clothes dryer <br />Range haod <br />ExAaustfan <br />Heat pump <br />Unit heater <br />_ Boiler <br />_I ReMgeratlon <br />Woodstove <br />CITY OF EVERETT LOCAL SALEi TAX CODE IS �106 <br />I hereby centily that I have read and examined this applicallon and knrnv the same to be hue and mrrecl All provisions of laws and <br />ordinaces goveming lhis type of work will be mmplied with whether spe�fied F�erein a not The grandng ol e permtt dces not pesume <br />to give authonty te vinlate cr cancel the provision of any other state or la:,l iaw �egulating conshudion or the performance of <br />construct�on. Tha! I a��� �;;�ha¢ed by the owner of this propeny to perform the work for which applicetlon is made and I comply wdh the <br />Stale Conlradors Law 18 27 RCW and 296200 WAC. <br />.�\ . /J//�///�% �.l � .� /� /, <br />0 <br />0 <br />