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SI7E ADDRESS l�;-G <br />. � <br />ISiIi:G� <br />PERMIT' �I�PLIC/�TION <br />CITY OF EVERETi PERMIT SERVI�ES <br />3200 CEDAR STP,[ET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />2 `.��, �1/�I��T M�4 <br />BLOCK <br />TRACT OR <br />i.o. u , <br />��/ � ��G� <br />u <br />J y� <br />- � ! <br />, � <br />/ <br />'�t/-��L'::• �`� � <br />TENANT NAME CONTACT FOR PERMIT PHONE �� ij��] 2Q7�- <br />.J�r � T `-�M`✓�ry yT1�. E-MAIL �=.fafVLC�.�lL�� FlKOI <br />��� <br />CONTR. IICENSE q <br />USE OF BUILDING <br />HEATSOURCE <br />Eleciric Gas O�her <br />CONTflACT PRICE OF WORK <br />WOR�( DESCRIPTIUN "" " � <br />`7�.G hJc'✓LL�.;to7C�Ll�t-�, L�?D�•���t/d�% 7Z�"/1 - r��eCtG�Gvutil ��jdil�� <br />,`�pL �}r-�nQarrc� �ldG� K�ut'� �'lCAll'7fs� ��t�Gfill� , �CC� ��1ci7C1 � <br />� � , r, . , � _ / 1 �, ,1 .. � � _ -,� _ r <br />NO. I TYPE OF FI%TURE OR ITEM <br />0 <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes Washer <br />W ater heater - ` <br />Sink (service/bar/mopletc.) <br />Backllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease �rap <br />Roof drains <br />Other �...f.nr:�Ko�; <br />w. -�.�kr�r. <br />N0. I TYPE OF FIXTURE OR ITEM <br />NC - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />.�lothes dryer <br />RBn9e hood <br />Heatpump <br />Unit heater <br />Boiler <br />Re(rigeration <br />lNoodstove <br />CITY OF EVFRFTT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y �hat I have read and examined ihis application and know lhe same Io be irue and correct All provisions of laws and <br />ordinaces goveming �his type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authoriry lo violate or cancel the provision ot any other stale or local law regulating consiruction or ihe pedormance o( <br />construclion. That I am author ed by Ihe owner of Ihis property to perform the viork for which application is made and I comply wiih the <br />State Con�r�tors Law 18.27�CW and 296.200 WAC. <br />PiA�horized Agent� Date �� � <br />i/ <br />���..>> ( <br />