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PE�,tMIT 4PPLIrAT10�� <br />�G� CITY OF EVERETT PERMIT SERVIC�S <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />���� 425 �57 8810 FAX 425 2'7 88 <br />- - - - 5 - 57-www.everettwa.org _ <br />�lL� `_� �`�`/_) <br />APPLICATIONS ARE ACCEP7ED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />_, . <br />1; i' i <br />.EGAL LOT NO. <br />� BLOCK <br />PARCEL TAX I.�. # PERMITtf <br />C�os�l,17 oouoc i� oo I Cc�So y-G/�( <br />TRACT <br />2ez-oi5- <br />•,••,•-•• ..��n��� � uniur rnunt e10 (n • <br />__Lll' �L'�l Yl NGYl1P S I�� . I OI ;� I�' �+�� r� r�'� t/_��u F,� rrr^�} US'�Uy 'y78• 4S`/ <br />TENANT NAME I CONTACT FOR PERMIT' PHONE <br />CONTRACTOR ADDRESS CITY2IP pHONE <br />i�f�LbClY1 �iOr�lf`� L �c. io�a i�'ccr��cr� i LJ J�.ui>.Yr�(�%�'�O�/ �CL�' `/7S"• (v��/�7 <br />CONTR. LICENSE # <br />ARri-5 ���ass�� <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />'� � . ii ����_�- ( �lr!�._-. <br />I�FSi��PYI{- 1 /1� _Electnc �Gas_Other <br />IWORK DESCRIPTION <br />�'��'� l'i�� � '�' � 1� �=�'1 <br />NC. I TYPE OF FIXTURE OR ITEM <br />�_� ToilBt <br />_� Bathtub <br />•� Lavatory (wash basin) <br />_L Shower <br />� Kdchen sink 8 disposal <br />� Dishwasher <br />�_ Clcthes washer <br />_� Laundry tray <br />_I Sink (service'badmop���c.) <br />� BackCow preventer <br />_I Unnal <br />Gnnking i uuntain <br />_I Floortlrair. <br />_ Grease trep <br />�IRcof drams <br />Other <br />N0. � TYPE OF FI?.TUR[ OR ITEM <br />NC - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas firzplace <br />Gas renge <br />Clothes dryer <br />Rangehood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiier <br />Refrigeration <br />Wacdsrove <br />Other <br />CITY 7F EVERET7� LOCAL SALES TAX CODE IS 7105 <br />'� hereby eeriGfy that I have read and examine� this application and know tha same to be true and mrrect. All provisions o( laws and <br />.rr,inaces governing this rype of work will be complied �.vith whether specified herein or not. The granting of a permit does not presume <br />�� gi �e acthonty to violate or cancel the provisic�� of any other state or bcal law regulating construction or the performance of <br />"ristructioa 7hat I am authorized by the owcer ot this preperty+o peAorm tne vrork (or which application is made and I comply with the <br />�ate�antractors Law 18.27 RCW and 296200 WAC. <br />S�y ure o OwnenContractorrAuthonzetl Agent Dale � 1�/Z J <br />\ > <br />