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SITE ADDRESS <br />� <br />�� �/L I <br />LEG LOT NO. <br />TENAHTNAME <br />t5cn�� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 42�257�857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />6LOCK <br />c�c�- <br />�� � <br />PARCEL TA7C I.D. S <br />� z`�v�/Zti!'x� roo <br />71tACT OR SUBDMSION A <br />�L <br />COlITACT FOR PERMfT <br />G.� i�l�lnMS <br />Sr�tr-r�s <br />GOfi 1 KAG WK "--'—'- <br />Src"�NnrcR�� �c f !.�/SA- �'���u.�1y l�Z r,r� <br />CONiR. LICENSE K�� �7N �� L� ClZc� �"'3 <br />! <br />USE OF BUILDING <br />[�ik�t—' C)-F-�'ICCc- <br />��� <br />HFAT SWRCE <br />ElecUic _ Gas _ ONer <br />WORK DESCRlPTION <br />%/JJ'i/-�L(;, C�� W�LC_ JI�7� <br />NO. I TYPE OF FlXTURE OR fiEM <br />Toile[ <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />IGtchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Waler heater <br />Sink (servicelbadmopletc.) <br />Backflow preven[er <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />PERMIT # <br />S /OD�' D <br />'�:�'■`.�= <br />PHONE �� y� C���S <br />6G �!z°'6 U`6SS <br />i3 <br />CpNTRACT PRICE OF WORK <br />�� (, zCJU <br />NO. I TYPE OF FlXiURE OR REM <br />NC — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />ReFrigeration <br />Woodstove <br />Other <br />CfTY OF EVEREIT LOCAL SALES 7AX CODE IS 3705 <br />I hereby certiiy that I have read and examined this appliption and know the same to be lrue and correcL All provisions of laws and <br />ordinances goveming this lype oP vror!c will 6e complied �vith svhether specned herein or noL The granting of a pertnil does not presume <br />to give authority to viola[e or cancel the pro�rision o� any other state or local law regulafing consWction or the pedortnance of <br />consttuction. That I am aufhoreed by the owner oi this pmpert� to perform ihe work for which application is made and I comply with lhe <br />Staie Contractor La��v 18.27 RC4V and Z9o.2Q0 WiAC. <br />q � /d <br />�� �/2 <br />