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�-cRMIT APPLICAT�t�1N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEREiT. WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />�1/ 7 APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �D "(�'f �' <br />/ <br />SI7'E ADDRESS P�RCEL TAX I.D. A PERMIT N <br />� r.�s �; . ,( f :�,� �� CD�-U�} -O 1 C7 <br />LfG LO7N0.� B�UCK TRIlCT !--9'I- <br />y< < <br />�� / ,c ` .� <br />nooRess <br />�'✓ /X�,1 .�t�f l� <br />ICONTACT FOR PERMR <br />� `�' :s�� <br />� <br />CON(RACTOR ��-f/? (-C�•�h117��Cr/`�.� ADDRE33 „ .� CfTY21P . <br />i --�.n ��: �7 /���:si. ��'.�G i%%���)�>����. <br />COII7R.LICENSERf/I",iii)�� �t `)S � . . 7 �' � `"�cl� 7U <br />, o LC_ : .v� [�✓ �,� <br />USE OF BUILDINO <br />HEAT SOURCE <br />WORK DESCRIPTION ,, <br />v>�� �� �. 7.��� <br />N0. I TYPE OF FUCTURE OR 17EM <br />Tollot <br />Bathtu6 <br />Lavatory (wash basin) <br />Showar <br />Kitclien sfnk d disposal <br />DlsMrasher <br />Clothes washor <br />Wator heater <br />Sink (snrvica/bar/mop/etc.) <br />Backllow praventer <br />Urinal <br />Drinking Fountaln <br />Floor draln <br />Greaselrap <br />Rooi drains <br />Olhor <br />Gas Olher <br />PHONE <br />��� l- <br />J�' -, �.'��r(.� <br />PHONE �1�5 , <br />_/1)� ' .�%l y(.7 <br />CONTRACT PRICE OF WORK <br />���',� <br />.rr.� .�• . �_,� •_ .: �� u <br />A/C - air handling unita <br />Forced alr syslems <br />Gas pipinp <br />WaWr heator <br />Gas fueplace <br />Gas range <br />Gofhos dryor <br />Rargo hood <br />E#ieust fan <br />Heat pump <br />Unll hnater <br />Boiler <br />Ref�igeratbn <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAJ( CODE IS 7105 <br />I hnraby ceritity that I have road and examinod Ihis applicalion and know Ihe same lo be true end cortect. All provislona o( laws end <br />ordinacas gavaming this typn of work will be complied with whether spedfled horein or not The grantlng o1 a pennit doe,+ not presume <br />to give autho�ity to Wolato or cancM the proWsbn of any olhor stalo or bcal law regulatlng canstrudbn or the per(ortnance o( <br />consWcllon. That I am aulhor¢ed by tho ownor of this proparty to perfortn tho work for whirh epplh�tbn Is mede and I mmpy wllh tlie <br />Slalo Cantrautors Law�1817 RCW ,�nd 29Fi.2IX1 WAC. <br />, /' ��J ''') <br />/ .I'f� L ' ��� %�� �-"�� �. � / ��� / <br />1' <br />Z <br />