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PL��VIIT APPLICATIG�J <br />CITY OF EVERETT 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 />SITEADDRESS &,��� �,UQ C{�Oy pARCELTAXI.D.i� � PERMIT# � <br />q�a�( G 1 �-� <br />LEGAL LOTN� � BLOC TRACT <br />nvor . _ i � <br />�wntrc qooREss � CITYIZIP PHONE <br />� �1 i� V� �� c� � � I Cf ��'X."��— `�� �C�N''C� ��.�JCi C( �< <br />TENANT NAME ` I r CONTACIT FOR PERMIT PHOilE <br />�.�Z���1"�n �1-1-c.1�o _ �,�ZbC'�L� �--����t r o CyaS> �laa ��B�G <br />CONTRACTOR ADDRESS <br />T� a n1-� �onza Z � 6aia <br />CONTR. LICENSE # <br />r�a �' � 5��,� c��, �� S� <br />USE OF BUILDING HEAT S <br />. <br />� �C�r� �� � '��., � _ Electric�� <br />WORK DESCRIPTION <br />��ec�-s � c S�cyn �O Ue �1c�ce� <br />J <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub / � <br />Lavatory (wash basin) <br />_ Shower /' <br />Kilchen sink & disposal <br />Dishwasher � <br />Clothes washer ' � <br />Laundry tray <br />_ Sink (service/badmop/etc.) i� <br />_ Backflow preventer � <br />_ Urinal j <br />Drinking Fnuntain <br />_ Floor drain � �� <br />_ Grease trap / <br />Roof drains <br />Other <br />Olher <br />I CITY2IP PHONE �y�.31 <br />1 � �.lk� S� �' 30-�s16C7 <br />� ��� c��� c�� ��o�� <br />ICONTRACT PRICE OF WORK <br />�-��,� CO <br />o n �c� <br />� 3�,���,�,y <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gasfireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3�05 <br />I hereby ceritify that I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br />ordinaces governing this lype of work will be complied with whether specified herein or not. The granting of a permit does not presumE <br />to give authori y to violate or cancel the provision of any other stale or local law regulating construclion or the performance of <br />construction. �hat I am aulhorized by the owner of lhis property to perform the work for which application is made and I comply with tha <br />State Cont�,a¢tors/�w i8�27 RCV� and 296.200 WAC. <br />'/a <br />6 <br />