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PE�MIT APPLICATIO�� <br />CITY OF EVERETT PERMIT SERVECES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org ! �_ a O-0 u <br />7 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />�� l.f�'c�l� <br />LEGAL LOT N0. <br />DESC. l <br />OWNER <br />� �� L� <br />TENANTNAME <br />J�a,� �-�v�,..o <br />CONTRACTOR O�NO'�L <br />CONTR. LICENSE # <br />USE OF BUILDING <br />CZ�'!a-��,r <br />WORK DcSCRIPTION <br />(�r1.tit,'cz�� �2:;�0,� <br />PARCEL TAX I.D. # <br />BLOCK ' TRACT <br />Z AD R�ESS <br />�00 � �T{31 <br />ONTACT <br />3,�� � <br />ADDRESS <br />HEATSOURCE <br />_ Flectric �Gas _ Other <br />, �c� i2���e�� �ta (.G�NGe <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bslhtub <br />Lavatory (wash basin) q��; Py-t,,.� <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc.)�'Z� h1�n��wR:�r1� 7j c�.�.SYr�- <br />Backflow preventer �,-.� � 5�,,, � <br />Urinal <br />Drinking Fountain <br />Floordrain wo���cc� <br />Greasa trap <br />Roof drains <br />Other <br /># <br />C'.�v <br />'�!31 <br />CONTRACT PRICE OF WORK <br />D�I- � � _ � <br />TYPE Of FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaustfan <br />Heatpump <br />Unit heater <br />Boiler <br />Refngeretion <br />Woodstove � \ /� <br />O:her 11�Yf— <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />I hereby cerilify that I have read and examined this application and know the same to 6e lrue and correct. All provisions of laws and <br />oroinaces 3ve nir,g this type of work will be complied wilh whether specified herein or not. The grenting of a permit does not presume <br />to give uthority�o vialate or cancel the provision of any other state or local law regulating construction or the performance of <br />const ction. 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 />State onlracydrs Law 18.27 RCW and 296.200 WAC. <br />I V/�1� I J lN� � I ' <br />�� I4�1� <br />':;.,,.� 1-�1�� <br />0 <br />l� <br />