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P�RMIT APPLICATI(,.�V <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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />��io� C�11� <br />LEGA l07 NO. <br />=Jr UIC� ' <br />TENANfNAME <br />A,� e <br />BLOCK <br />CONTRACTOR j �-\� Il-��.ir � `�m� <br />CONTR. LICENSE p <br />USE OF BUILDING <br />� <br />� t.'� � C�� �� C'� <br />WORK DESCRIPTI(ON <br />l�1 �.r:.', 1�t�n� `) <br />PARCEL TAX I.D. 7! <br />TRACT <br />ADDRESS <br />�.�I U I C � 11� I� <br />ICONiACiFOR PERMI <br />;1nc, ADDRESS <br />HEATSOURCE <br />�Eleclric _ Gas _ Other <br />I Y� j 1r. 11 l� � l C� l l <br />NO. � TYPE OF FI%TURE OR ITEM <br />Toilel <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry iray <br />Sink (servicelbadmop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Fioor drain <br />Grease Irap <br />Roof drains <br />Other <br />PERMIT# <br />Moso � -0�3 <br />CITY2IP PHONE i�� j - <br />tve��-i�- ��8703 �lio-ai�� <br />PHONE <br />CITVIZIP PHONE <br />2 ��b - 31r,� _ 3430 <br />� CONTRACT PRICE OF WORK <br />NO. � TYpE OF FIXNRE OR ITEM <br />wc - air nantliing units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhausl fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslova <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS J105 <br />I hereby ceritify Ihat I havo read and examined lhis applicalion and know Ihe same fo be We and correct. All prcvisions of laws and <br />ordinaces goveming Ihis lypo of work will bo complied wilh whether specified herein or not. The granting of a perm t does nol presume <br />to give aulhonry to violale or cancel Ihe provision of any olher state or local law regulating construction c+r tho performance o( <br />consiruclion. Tliat I am authorized by the owner o( this property to perfomi the work for which application is made and I comply with the <br />State Contraclors Law 18.27 RCW anJ 296.200 WAC. <br />�� i.,_�_�.. ��-i:t�� 0�1���-��(7:5 <br />