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P��MIT APPLICATI�r� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBR 3 CREDIT CARDS ARE NOT ACCEPTED <br />SITE AD�RESS <br />33J � <br />LEG L07 NO. <br />NAME <br />PARCEL TAX I.D. M <br />!'4 L Q � <br />BLOCK TRACT � <br />3 r.� <br />ADDRE33 <br />�n, D[xhn aeey 331a. F <br />ICO TACT FOR PERMIT <br />1 arry m��, <br />CONTRACTOR �Ome Z'/nP SerJ. <br />CONTR. LICENSE X i/�S HO�� O <br />/7 <br />ADDRESS <br />PERMIT i <br />` .33a.. <br />� � CRY21P PHONE <br />75/ 5 77 �r• sE. <br />�Q. <br />_ iasy <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />y� O� <br />1\ es ti dcYXL� _ ElecUic _ Gas _ Other Q� L s/ O �� <br />WORK DESCRIPTION "�`0 fema�� �+-�rat �py� (�a�1 4YLtiv��Q � i Ti.r�crV <br />{Zt�(@c:� S'ttuGrn.I.. B.s.a�►v� � cacrrr Go�R o� open s�w <br />Qzr i�Z�Zk m F;,�e, � nti i n�cr � � e�r � p�+'or. 9- 3o-oy-- �'� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dfshwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Vap <br />Roof drains <br />Other <br />NO. � TYPE OF Fp(TURE OR REM <br />AIC — afr handliog uNts <br />Forced alr systems <br />Gas piping <br />Water heater <br />Gas flreplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heatpump <br />Unk heater <br />Boller <br />Refigeratlon <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby ceritify that I have read and examined this applicadon and know the same to be We and correct. All provislona of laws and <br />ordinaces goveming this rype of work will be complied with whether spec�ed harefn or not The grantlng of a permit doea not presume <br />to give authority to violate or cancel the provision of any other state or local law reguladng consVuctfon or the perfortnance of <br />constry�tion. That I am authorized by the owner of this property to perfortn the work for which applfcatlon fs made and I compy with tl�e <br />State�bnVactors Law 18.27 RCW and 296.200 WAC. <br />, /D ^ <br />