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� .• <br />PERMIT APPLICATI�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wuvw.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM �fj .. � q,,,D 7 <br />SITE ADDRESS <br />n �y <br />�f�7�"' %i!�> ��:;rr� /;`'" . <br />�,. <br />LEG LOTNO BLOCK <br />DESC. <br />L. <br />PARCEL TAX LD. II <br />�/ <br />TRACT �`/ `( , '� r' <br />J <br />ADORESS <br />r�'✓/�Y�,� .�;��C, <br />I CONTACT FOR PERMR <br />`� <br />/ l ;i/� <br />PERMIT N <br />Ct;"�o'j - cG. <br />!-J <br />n <br />'�IJ �L'1Yi%r��/�i.�C: <br />IP PHONE <br />�r,�,�,•,/ `�,Y�'J/ <br />CCNTRACTOR �I�h�� �C���y!!r�<h:/✓ AppREA3 � � CITY2IP . <br />•-^ t 1'7 / �e:.si� �r . <br />•r �• • I - , �' /L. �'11:,r^ >'„� <br />CONTR. LICENSE B � � � ' � �7 � - � i ' � // y � ' � � <br />, �S ;� /� i. � }I ` � S � c C_ �'�a-Ps�g-� .-,�---r - � ✓ �{t ��. <br />USE OF BUILDING <br />WORK DESCRIPTION <br />HEAT SOURCE <br />Ekriric _ Gae _ Olher <br />.� (lil C- �.�`% <br />NO. � TYPE OF PIXNRE OR ITEM <br />Tollnt <br />Bathlub <br />Lavatory (wash besin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Wetor haater <br />Sink (sorvlcelbarlmoplotc.] <br />Backflow prevenler <br />Urinal <br />Drinking Fountaln <br />Floor draln <br />Groaso Irap <br />Roof dralns <br />Olhor <br />NO. <br />PHONE <br />+�%i ` <br />/,i=� ...-c� �L�`� <br />PH06E cf�;� <br />--'YC�' '�7v���� <br />CONTRACT PRIC[ OF WORK <br />n <br />`SC�� <br />TYPE OF FIXTURE OR ITCM <br />A/C - air hendl6ig unils <br />Forced alr syslems <br />Gas plping <br />Waler hearor <br />Gas flraplacn <br />�as ranpe <br />Golhos dryer <br />Rargohood <br />Exhaustfen <br />Heat pump <br />Unit hnater <br />Boller <br />Refrigerafbn <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS ]705 <br />I heroby cerilify Ihat I have read and examinod this applicatlon end kraw thn sama b be true end correct. All provlabna af laws and <br />ordinacos goveming this lypo of work will be mmplied with whether apeclfled horeln or raL Tho pranting af a permil doea nol presume <br />to give aulhorlty lo Wolalo or cancd tho pruvlsion ol any other slate or bcel law iegulatlrg co�aWdion or the peAortnance ol <br />constrvcUon. That I am aulhorized by the ownar o! tl�Is property to pertortn tho work forwhich applicatbn Is made and I comply with the <br />Slnlc CaNraolors Law,i827 RCW ,�nA 298200 WAC. <br />` , <br />' � • f "� �; �) L. .--� �r����� � <br />Sianatt�Re o�Owner ContractodAulhorizexl Aoent alo � <br />Z <br />