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FROhi : BP&H <br />FR': IJU. � 42rE44-99�73 I�sy. 23 2C��76 09t 36AI1 Pl <br />F�ERM13 APPLICATION <br />CITY O� EVERkTT E'FRMIT SERVICES <br />3200 CEDAR STR[ET, EVERETT, WA 98201 <br />425•257-8810 — FA>: 425-257-8657 — wv�nv.everellwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />�a'-O Ev�R 6.?E�it <br />LEGAL LOT NO. BLOCK <br />.,ESG. <br />OWNER <br />TENANTNAME <br />GONTRACTOR <br />CON7RLICENSEtt ��,�t�. <br />� <br />USE OF BUILDING <br />PnRCCL TAx �.�. q <br />TRACT <br />CONTAC7 FOR PERMIT <br />I 1'J'/�iK�.' C"oNov��� <br />fl�H���NQ ,h ADDRESS, • ,,,f% CITY2IP <br />N�Try- /`//</ NE'.2��� [�.� <br />/�if��FNv <br />� HEATSOURCE I <br />Eleclric _ Gas _ Olher <br />WORK DESCRIP�� ��� J �J�?/� y������� <br />�� T <br />NO. I TYPE OF FIXTURE OR ITEM <br />Tollet <br />Bathtub <br />Lavalory (wash basin) <br />� Shower <br />^ Kilcben sink & disposal <br />� Dlshwaaher � <br />� Clothes vr��he� <br />Laundry tray <br />Sink (sarvicelt•aUmop/etcJ <br />—' Backtlow preventer <br />� Urinal <br />Drinking Fountaln <br />T Fleordrain <br />Grease lrap <br />Roof drains <br />Other <br />NO. <br />s—a3�-o� <br />PERMIT t! I <br />Yv� (� (eG5-G S � <br />PHONE <br />��� 6 yr-�z�. <br />PHONE �� � <br />PRICE OF WORK <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />NC - air h�nJliny units <br />Forcod alr systems <br />Gas piping <br />Wdttr heater <br />Gas fireplace <br />Gas range <br />Clothes dryor <br />Range hood <br />Exhousltan <br />Heat pump <br />Unit heeter <br />Boiler <br />RefriyoraUon <br />Woodstove <br />CITY OF EVERETT LOCAL SALC•S TAX COD[ IS 5105 <br />I herehy ceritify that I have read and examined this application and know the same to be true and correG. All provislon5 of lews and <br />ordinaces goveming this lype o( work will be tomplied with whelher specified horoin or not. The grantin� of a permit doe5 nol presume <br />to giv¢ authority to violate or cancel the provision of any other state or Iocai law rogulating construction or the podormanco of <br />construclion. That I am authorizod by �he ownof o( thle property to pedortn lhe vrork for which appllcation i5 made and I camply with th� <br />St�te Contraclors Law 16.27 RCW antl 29620D WAC. <br />