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/�y PE.tMIT APPLICATiO�,� <br />(�/ CITY OF EVERETT PERMIT SERVICES <br />`7 3200 CEJAR STREET, EVERETT, WA 98201 <br />425 257 88 <br />- - 10 - FAk 425-257-8857 - www.everettwa.org /1 <br />}�G<V �� �� � l � <br />APPLICATIONS ARE ACCEPTED FROM 8.4M TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED � <br />SITE ADDRESS PARCEL TAX I.�. # PERMIT# � <br />i � � ,/ <br />:�I��'r� ' - � (, �; ��, O(.�SY�'7 vDoon l:c+u (`" Z;�,J - ;D <br />LEGAL LOTNO. BLOCK TRACT n�,r <br />DESC._ � <br />_. _ 13e���e�lu L�nP S�' �2r2 - v�'s_ ov <br />7ENANTNAME <br />ICONTACTFOR <br />PNONE <br />��• <br />y ��. <br />CONTRACTOR ADDRESS CITY2IP PHCNE <br />f��EibClrl i-�O�'.�E�ZriC.101alf'_�er�r�ri,��y�u�°.rr.t/qS�o�1 �O(e•�175'•G�9y7 <br />CONTR. LICENSE # <br />, USE OF BUILDING <br />i WORK DESCRIPTION � i� • \ !' ; ';'; <br />Na• I TYPE OF FIXTURE OR 17EM <br />� Toilet <br />�r Bathtub <br />lavatory (wash basin) <br />� Shawer <br />� Kitcher. sink 8 disposal <br />� Di;hwasher <br />�— Clothes washer <br />Lsundry tray <br />Sink (service/banmopietc.) <br />dackflow preventer <br />Urinal <br />Dnnking Fountain <br />Fioor drain <br />Grease vap <br />Roof drains <br />Cther <br />I <br />HEATSOURCE <br />_ ElecMc � Gas <br />�;,.-,: afl-i`1 <br />Other <br />CONTRACT PRICE OF WORK <br />N�• � TYPE OF FIXTURE OR 17EM <br />�vG — air hantlling u^.its <br />� Forced air systems <br />�� Gas piping <br />Water heater <br />� Gas fireplace <br />Gasrange <br />� Clothes dryer <br />/ Range hood <br />� Exhaustfan <br />� Heat pump <br />Unit heater <br />Boiier <br />_ Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 7105 <br />I hereby ce:itify that I have read and examine' this applic��ion and know the same ro be true and correct. All provisions o( laws and <br />ortlinaces geverning this rype of work will be complied with whether specified herein or not The grantin� of a permit does not presume <br />m 9ive authonry to violate or canczl the prcvision of any other state or local law regulating constructlon or the performance of <br />construction. 7hat I am authonzed by the owner of this property to perform the work (or whi�h application is made and I compiy wilh the <br />State Contractors Law 1827 RCW and 296.200 WAC. <br />S�r,nature of OwnenConvacronAuthonzed Agent Date % � 1 <br />�� <br />