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PE`rtMiT AF'PLICAT��Oiv <br />G1�'`�' OF EVERETi PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-25"'-8857 - www.ever2ttwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 A�JI TO 4 f�M - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADORESS PARCEL TAX I.D. �F PERMIT #�% i <br />n <br />77as– C�cKy���;,�,�, ��'os-o� �o� �' o P,�oG -/� <br />LEGAL LOTNO. BLOCK TRACT � <br />��Ol�cj �VIC. 3Lk7 F%r�'l�l�i'JI !�-OC��j <br />�i� La�-s . csaGv;�dvs o�+-i� �l3.;.�-� �'y/ �-9b' �d'o� <br />TENANT NA�1E CONTACT FOR PERMIT PHONE <br />� r� i v- CJE+ f-s ��v;,-� j7r o �r s,= �v �1 i 7s-S` YO S�i'— <br />CONTRACTOR `��r I7LV ;y� 13i yl � ADDRE� G� I D 3��� �i TY� � PHON�p ,`35 <br />lsi <br />Ci r�- � <br />CONTR. LICENSE S �j- nL � (J � I J C:� c �' S�� <br />J !I1%�-r_ys�:l�� ��i-r ?�a�c.� � <br />USE OF BUILDING <br />1 /�-i(� <br />WORK DESCRiPTION <br />I� C W o �2 (�- <br />rCcs TK o�+� <br />NO. I TYPE OF FIXTURE OR ITEM <br />� Toilet <br />Bathtub <br />L Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />� � Urinal <br />Drinking Fount2in <br />I 'Z Floor drain <br />Grease trap <br />I Roof dreins <br />! Other __ <br />HEATSOURCE <br />Eler.tric _ Gas _ Other <br />�; iti Y }'L <br />`'"� % z' � � <br />CONTRACT PRICE OF WORK <br />rr� <br />�Ys� — <br />n <br />cr� r.J' v ti. vi ?�S ,L f't Lw <br />MECHANICAL <br />IiL�2 <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />I hereby ceri;ify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />� ordinaces goveming this rype of �,vork will be complied with whether specified herein or not. The granting oi a permit does not presume <br />to give authonty to violate or cancel the provision or any other state or local law reaulating construction or the performance of <br />construction. Th�t I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Slate Contractofs Lawa$!27 P,CW and 296.200 WAC. <br />