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F �RMIT APPLICATIvN <br />CITY OF �VERE�'T 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 A`ODRESS <br />/ �� <br />LEGAL� LOTNO. <br />DESC. <br />OWNER <br />� <br />TENANT NAME <br />� - <br />CONTRACTOR �,�C <br />CONTR. LICENSE � <br />USE OF BUILDING <br />�� <br />WORK DESCRIPTIO <br />E i <��-C �� <br />BI,OCK I TRACT <br />�' I^f��('..0 �1 �'1 <br />PARCEL TAX I.�. # <br />CONTACT FOR PERMIT <br />ADORESS <br />!N� <br />12f13 <br />HEATSOURCE <br />✓ <br />Eleclric Gas �Olher <br />PERMIT # <br />�o�o�- <br />PHONE <br />;� �/�y"�/�/- �(o[� <br />CITY2IP PHONE <br />/'YIL(.-t C�f=i- C <br />������K � 1���� <br />I CONTRACT PRICE OF WORK <br />" /-1 � I�J � ►^� � � Spr� �'1 �C� c- 11.r� �'c�_ Js , C �1cv��.� c�2c <br />G�t.CGYc��, c;,cci�c�E �2�-1- (r��� l�-,�'C<<Is �`"C-� r�tCLdeh <br />'r ({?(S� ��C�C) � 11p �c� �' ��06�"C 1�1'L7�'1 f— <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />W ater heater <br />Gas ,'ireplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil healer <br />Boiler <br />Refrigeration <br />Woodstove <br />� <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS <br />" ` !1� / iCc (� L � <br />�1CP�� . � C,�{'% <br />i hereby ceritify that 1 have read and examine� lhis application and know the same to be true and correct. All provisions of laws and �' <br />ordinaces governing this type of work will be complied wilYi whelher specified herein or not. The granling of a permit does nol presume <br />to give authority lo violale or cancel the provision of any olher state or local law regulaling construction or the performance of <br />construction. That I am aulhorized by the owner of lhis property lo perform the work for which application is made and I comply with lhe <br />Stale Contractors Law 18.27 RCW and 296.200 WAC. <br />n�,,,� ��;� �-�� �.�5_ �� <br />JrrS <br />� <br />