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P'��MIT APPLICATI(�nl <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org /J � �_, <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE qDDRESS <br />LEGAL LOTNO. <br />DESC. '�j 4 <br />G <br />NAME <br />� � � � �� <br />- DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />PARCEL TAX I.D. # <br />0 0 41'11 UOoO 33 00 <br />e�ocK R��GRT O F�.oT i;(,'�" <br />} �,n (o � �I U S�7 Awrcesa <br />;NR I 7q25 30o gT p�BT N w <br />CONTRACTOR <br />CONTR. LICENSE k - �.� L-� � <br />USE OF BUILDING <br />sI�l1G�L6 Ffl��►�L`( <br />ICONTACT FOR PEFMIT <br />� �-�Y P� w �� <br />ADDRESS <br />v �' <br />MIT p <br />�'l� - � <br />i; _ _ . -, ` <br />�i-I�ANwooj7� wA o�g 2°12 <br />PHONE <br />HEATSOURCE <br />_ Eloclric _ Gasi� Other <br />WORK DESCRIPTION <br />�J6W SINGLE �}MILY <br />NO. I iYPE OF FIXTURE OR ITEM <br />�ioilet Ili� <br />5athtub I1 � <br />Lavalory (wash basin) /'/'F/ <br />Shower i/ <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry iray <br />Sink (service/badmop/elc.) <br />Backllow prevenler <br />Urinal <br />Drinking Founlain <br />floor drain <br />Grease trap <br />Roof drains <br />Olher <br />�2S-�� I-oSaJ <br />:ITY21P Pk10NE <br />" ._ ; �, �, <br />CONTRACTPRICE OF W0�2K <br />� 400, oo� , <br />'7=� �'_- <br />NO. I TYPE OF FIXiURE OR ITEM <br />A/C - air handling units <br />�� Forced air systems <br />Gas piping <br />�_ Water heater <br />Gas fueplace <br />� Gas range <br />= Clothes dryer <br />� Range hood <br />Exhaustfan )hG( / <br />1 Heal pump <br />Unit heater <br />Boiler <br />-� Refrigeration <br />T Woodslove <br />CITY OF EVEREIT LOCAL SALES TAX COOE IS �105 <br />I horeby ceritify Ihat I have road and examined th:s application and know the same to be true and cortecl. All provisions of laws and <br />ordinaces governing this type of work witl be complied with whether spocifed herein or not. The granting of a permit does not presume <br />to give authority lo violate or cancel tho provision of any other stale or local law regulating construction or the peAormance of <br />conslruction. That I am authorized by tho owner of :his property to peAorm the work for which application is made and I comply wilh the <br />Stale Contractors Law �1J8.27 RCW and 296.200 WAC. <br />c—� ►T'I�1 . 1 0-WkA. � "`I W` O/L � O S <br />Signature ot�i w er/ContractoriAuthonzed Agent Dale �'y <br />