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P��2MIT APPLICATIDs� <br />;'� CITY OF EVERETT PERMIT SERVICES <br />� 320U CEDAR STREEl, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-£957 — Hr,wv.everettwa.org , �� <br />�J �,�c� i <br />APPLICATIOtJS ARE ACCEPTED FROM 8 AM TO 4 pM - DEBIT 8 CREDIT CAI2DS ARE NOT ACCEPTED <br />SITE AUDRESS <br />I .'��-�� i, <br />I LcGAL LOT N0. <br />DESC. � <br />BLOCK � TRACT <br />PAR�EL TAX I.�. # PERMIT # <br />C� D S � a' �] 00000 p C O C���;—C(iC; <br />'t��<1"O <br />I- . .. ...,..�."... v ..i � nur rn�ne e10 (c • <br />i %� r f � �-rt �� Ho���P S I��C . �OI "� I�'-���3 r e�� � rrr�f �7,5 p y78• <br />iTENANT NAME I CON7ACT F'7R PERMIT' PHONE <br />I <br />GONTRACTOR ADDRESS CITY2IP PhONE <br />•qrEi•50.r� NG�r�tS�iC.. lolal E'_�r�c��cr>iLvc� �-v�'.+�ett`�j5�0�1 �Cln•`r7s�•W�y� <br />CONTR. LICENSE It <br />USE OF BUILOING <br />� <br />� � II�:L'��� � F���I�L�i <br />WORK DESCRIP710N 1 ' � �'� � �, I ` ',' , <br />LU <br />NO. � NPE OF FIXTURE OP ITEM <br />L ioiet <br />Ba:htub <br />L Lavatory (wash basin) <br />Sh�wer <br />�� Kirhen sink 8 disposal <br />� Dishwasher <br />' Ctothes w�sner <br />Laundry tray <br />Sink (serviceibarlmopletc.) <br />Backflow preventer <br />Urinal <br />Dnnking Fountain <br />_ Floor drain <br />_ Grease trap <br />Roof Crains <br />Cther <br />HEATSOURCE <br />_ Electnc � Gas _ Other <br />� ., , „ <br />CONTRACT PRICE OF WORK <br />N0. � TYPE OF FIXTURE CR I7EM <br />wc — air nanaiing unils <br />L Forced air �ystems <br />3 Gas piping <br />= Water he�!er <br />L Gas fireplace <br />+ Gasrange <br />L Clothes dryer <br />1,_ Range hood <br />� E�aust (an <br />Heat pump <br />� Unit heater <br />Boiler <br />Refrigeration <br />Woadstove <br />Othar <br />CITY OF EVERETT LOCAL SALEa TAX COOE IS J705 <br />I hereby :eriufy that I have read ard examined this applicaG:�r and Know the same to be true and correcL All provision; o( laws and <br />ortlinaces govemmg Ihis rype of work v�ill b� �.�mplied with �•.nether specified herein or not. The granting o( a permit does not presume <br />m cive authonty to violate or cancel �he previswn of any other state or local law regulating construction or the performance of <br />construction. Tnat I am authorized by the owner of this prooerty to pedorm the work for which application is made and I rAmply with the <br />State Ccntr2ctors Law 1&.27 RCW and 296.200 WAC. <br />S�gnature of Owner�Contrac:oriAuthonzed Agent Date <br />