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PtRMIT APPLICATI(�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 – FAX 425-257-8857 – www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />`iiE ADDRE�S^S r <br />~ l� L � U G <br />I.EGA LOT NO. BLOCK <br />DESC. <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION R <br />'r��' � <br />VYII'ICR MVVRCJJ vn ua�r � n�n� �" � <br />7Av���HuEtZMqN 50f� Co(.3Y AvE EVEREII-981o3 qzZ-�6a7 <br />T[NANTNAME I CONIACTFORPERMIT PHONE <br />� E-MPJL <br />NTRACTOR <br />CONTR. LICENSE p %%�/ ,'� A � L� <br />UL���/ ��� � <br />USE OF BUILDING <br />HEATSOURCE <br />Eleclric Gas Other <br />WORK DESCRIPTIC�N � <br />FZeplace ,�a(� K;zeo( ��pp�es �� 3 ba. �oow�s, 2 I <br />I��aCe �Oai�i�roow. �c�u.s'��ah ar� ��,s'��� v�ew <br />... . ......—. '�� �. �e. � �^-s�.- �c,1--, � , v <br />NO. I TYPE OF FIXTURE OR ITEM <br />�� <br />Tuilet <br />6athlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & dis�h�sal <br />Dlshwasher <br />qolhes washer <br />Waler heater <br />Sink (service/badmo;�lelcJ <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />CONTRACT PRICE OF WORK <br />s, �' l (au�Qrr . <br />�ow� P�c.�u5r'�}q <br />NO. I IYPE OF FI%TURE OR ITEM <br />A/C - air handliny units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas lireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />� Exhaust fan <br />_ Heal pump <br />Unil healer <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TA7C CODE IS 1105 <br />1 hereby cerilify tbat I have read and examined this applicalion and know lhe same lo be lruo and correct. Ati provisions of laws and <br />ordinaces g�veming lhis lypo o( work will bo complied with whelher specified herein or not. Thr granting oi a permil does not presume <br />to give authorily to violale or cancel tho provision of any olhcr state or local law regulaling construction or lhe per(ormance of <br />conslruclion. Thal I am authorized by lhe uwner ol Ihis proparty lo pertorm lhe worh for which application is made and I comply with the <br />SI2le Conlraclors Law 1.27 RCW and 29G.200 WAC. <br />�q.v {� b�/7 <br />Sigr,aWre o( OwnedConlraclor/Authorized Agen� Date <br />� <br />