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r— — <br />PL,�MIT APPLICATIO�� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-E810 — FAX 425-257-8857 — www.everettwa.org , <br />` �' = ` �CI � '} ii <br />�; <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDI'f CARDS ARE NOT ACCEPTED <br />SITE ADDRE55 <br />LEGAL� L07N0. <br />DESC.� ) <br />TENFNTNAME <br />BLOCK <br />PARCEL TAX I.D, # <br />c o 5`i b' 70000o b <br />TRACi <br />ICONiACTFOR <br />p <br />,�/ - �,� <br />SP �2uZ-O�y-oY <br />Y/ZIP PHONE aO � • <br />�,i'PfP'tI �%%�O�/ �178• <br />PHONE <br />CONTftACTOR A�DRESS CITY2IP PHONE <br />•qr f i�0.�`l No.r�es L� iC.. lo l� l E'_ier�rcri� W� �-v��.rr'�-! q 52oy 3C(.� • Y7S'• Cv`7�l'7 <br />CON'fR. LICENSE p <br />� ARrT.tliz9s c� <br />USE 0� BUILDING I F{EAT SOURCE � CONTRACT PRICE OF WORK <br />_ Electnc � Gas _ Other <br />WORKDESCRIPTION { I��,,, i'' ", ; ;',�•.� t� i.,�l <br />PLU <br />NO. I TYPE OF FIXTURE OR ITEM <br />IToilat <br />P,:;ntub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry trey <br />Sink (service�badmop/etc.) <br />Backflow preventer <br />Urinal <br />Dnnking Fountain <br />Floor drain <br />?rease trap <br />F�ocf drains <br />Olher <br />NO• � TYPE OF FIICTURE OR ITEM <br />/vc — av h2ndiing units <br />� Forcea air systems <br />Gas piping <br />� Water heater <br />� Gas fireplace <br />Gas range <br />T Clothes dryer <br />�� Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />O;her <br />CITY OF EVERETT LOCAL SALES TAX CO�E IS 7105 <br />i h�reoy ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />�;minaces goveming this rype of work will be complied with whether sper.ified herein or not The granting of a permit does not presume <br />to ;ive authonty to violate or cancel the pwvision of any other state or local law regulatirg cnnstruch'on or the performance of <br />:;onstruction. That I am authorized by the owner of this property to perform the work (or which application is made anA I comply wilh the <br />State Contrac;ors Law t8.27 RCW and 296.200 WAC. <br />S�gnature of Ownen ontractovAutho�ized Agent Date �� <br />d <br />