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SITE ADDRESS <br />LOT NO. <br />DESL'. <br />PtRMIT APPLICATIf�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9fi201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARF ACCEPTED FROM B AM TO 4 PM <br />BLOCK <br />PARCEL TAl( I.D. # <br />5/. <br />7_.�.r/gJ <br />�ERMIT # <br />�� � �� <br />�� <br />7 <br />TENANTNAME � CONTACTFOR PERMIT PHONE <br />�c,- b►•�• l-1� ns�� Mikc •ClirS�� y�S— �.2� — e2535 <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />�arse+� !� 8,�5 '�1 r' ��. .sf Sx�io,��sA 9�z9c ;�s- 3d�—,2S.�S <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION I L <br />{�[tY" /RA���10� <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />Toilcl <br />Dalhlub <br />Lavalory (wosh basin) <br />Shower <br />Kitchen sinA 8 disposal <br />Dishwasher <br />Clothes washr.r <br />Laundry tray <br />Sin� (servir.e/bar/mop���lc � <br />BackOow prevr.ntr.r <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher_ _____ <br />HEATSOURCE <br />� Eleciric _ Gas _ Olher <br />`/ X � <br />NO. I <br />CONTRACT PRICE OF WORK <br />� v? �^DD . `� <br />TYPE OF FI%TURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler healer <br />Gas fireplace <br />Gas rengc <br />Clolhes dryer <br />Ranoc hood <br />Ezhaustlan <br />Heat purnp <br />Unil healer <br />Boiler <br />Rclrigeralion <br />Woodstove <br />Olher ___ <br />CITY OF EVERETT IOCAL CALES TAX CODE IS J105 <br />I, I hereby ceritify lhat � have read and examined lhis applir,aGon and know tho same lo be lruo and correcl. All provisions o( laws and <br />�;r�inaces poverniny this rype of work will be complir.d with whelher specified herein or noL The granting of a permit does not presume <br />� to givo aWhority lu violate or canrel lhe provision of any other state or local law regulating construction or the performance o( <br />Iconslruction. That I am authorized by Ihn owner of lhis property to pertorm ihe work for which application is maAe and t comply wilh lhe <br />Stato Conlractors law 1U27 RCW and 296.200 WAC. <br />I �--� � / ' � �=-�-as- <br />� Signalure u� OwnodConhactor/Aulho zed Agenl Dale <br />� '/'r, <br />� _ - _ _ _ ____ _------- --------- -- - -- <br />