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�-v� <br />LOT NO. <br />P�RMIT �PPLI�ATION <br />GITY OF EVERE�T i�ERIIAIT SERVICES <br />3200 CEDAR STHEET, EVERET?, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evcrellwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />J�'1 1ni G�' <br />BLOCK <br />IN �����v ('�'���h� ����v1 �w �j <br />"cNANi NAF1E <br />`7['�V�vU���' �,1��'1�-Z-C� <br />coninnc�un <br />Z �nL. ��c �"C VVV� �Vl.�c�-- <br />CONTR. UCENSE JI <br />USE OF BUILDING s tq �F (3 11L�C� <br />� �.i ���� �i. t. � l�� � � Vl� : J.j C7 <br />PARCEL TAX I.D. # <br />, , � ,_ <br />TRACT OR SUBqVISIDN It <br />4't,V IVJ ' �',v�. <br />CONTACT FOR PERlAIT <br />I�i i l v\,� rh�._�T1�'1 <br />—, _� 3_0>3 <br />PERMIT # � <br />�-�.t� ' 'il.�•' Da-� <br />VRIP PMONE/LIZ� i y_2 � L� !�1 <br />� � JJ f V � <br />,I l��.V� ��'l;�t.,+��1 <br />PHONE LZOV � %l'v� .. ("�c"1(y'� <br />E-Ma��,,,.:��� e�v��nr��a�;��,:�c,c.tc5.wm <br />�O �� �� ��—ID'Cj�1 <br />HEAT SOURCE <br />__ Eteclric � Gas _ Othcr � <br />CONTRACT PRICE OF WORK <br />�� 1 �� �. � �� vl �J <br />WORK DESCRIPTION <br />�L 1 1z> .� <br />����i ;,';���i �+�/ �� ���rv\� c, v�-v�l SI�L,ti�1\ t��-�� 1��. .,, �� . <br />NO. I 7YPE OF FlXTURE OR IlE1A <br />% Toilet <br />Bathtub <br />__� Lavatnry (wash hasinj <br />Shawer <br />Kitthen sint & disposal <br />�_ Dishwashcr <br />Clolhes washcr <br />_j_ Wa1er heater <br />Z Sin:t(sr.rvice;barrmop:� <br />Backflow preventer � <br />-- Urinal <br />Drinking Fountain �� � <br />_i,� Floart3'�ein �71�✓ ��' <br />_ Grease lrap . <br />Root drains <br />Other <br />NO. , TVPE OF FlKTURE OR ITE4A <br />_ � A�C — air handlin� units <br />Forced air syslems <br />� Gas piping <br />I Water heater <br />Gas fiteplacc <br />Gas range <br />_ Clothes drycr <br />_ Rangehoad <br />Exhaustfan <br />Ncat pump <br />Unil heater � <br />Boilm <br />Refriperation <br />Woadstove . � <br />CITV OF EVERETT LOCAL SALES TAX CODE IS JI05 <br />I hereby ceritify Ihat I have read and ezamine� �his application and know Ihe same to be truc and corree!. All pwvisi�ns of laws and <br />ordinaces govemin0 this rype of work wdl he complied with whelher speciticd herein or not. The qrantinq of a permit does not presum� <br />to give authority to violate or cancel the provision of any other state or loeal law regulating construction or the performanr,e of <br />c:onslruction. Th�t I am aulhorizr.d hy Ihe owner of ihis property lo perform the wo�k lor which application ia made and I�nmply ivith Ihe <br />Cto�n Cnulrnrtnra I aw 1A ?7 RCW and 296.700 WAC. <br />`, 11 l ,� ;1 y, ��� <br />_�u_v-� <br />