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x' <br />P�,RNiET <br />A�PLICATI(�N <br />C1TY OF EVERETT PERMIT S�RVICES �� �5�7 �j� <br />3200 CEDr,R STREET, EVEREI?, WA 98201 L <br />425-257-Si310 - FAX 425-257-8857 - www.everetriva.org J�� �_ � <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TQ 4 PM - DEEIT &:REJIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # f�' PERMIT # \ <br />(�iOZ 5:— t_JG2c,-i M,��� Wn j I$(7�b5 --(�2�i j <br />LEGAL LOTNO. BLOCK TRAC7' <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />CLp N��`j l�.ar� ��lz.t.,r-r-r ?�76`4Sb'-�9J9 <br />CONTRACTOR ADCRESS CITYIZIP PHUNE <br />►�1fc�Fl� SIGN F2FcT�,�S (r+� `l:`iZ E�l��nc�.�a-s w5h ut�Z �pmotios ,.9oZ�J <br />CONTR. LICENSE # <br />f�fY 1 F S� ci aS C�C. ���-� `7 c� - 3i �/C _ <br />USE OF BUILDING I HEAT SOURCE � CONTRACT PRICE OF WORK <br />Eleclric _ Gas _ Olher I f y��'�� <br />WORK DESCRIPTION ' �j5 �(YL�._ 1 l_L�..� q„ � N � .- �y, �—�T � 25 ��.�� i � 4 <br />NO. � <br />PLUM <br />NPE OF FIXTURE OR ITE�7 <br />Toilet <br />Bathtub <br />_ Lavalury (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (service/badmop/elc.) <br />BackOow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. <br />« .� <br />Cj(�� N �}v�� <br />TYPE OF FIXI'[iAE ON f(EM <br />A/C — air handling u.ii:, <br />Forced air syslems <br />Gas piping <br />W ater heater <br />Gas fireplace <br />3as range <br />CI� thes dryer <br />Range hood <br />Exhaust fan <br />Hea[ pump <br />Unit healer <br />Boiler <br />Refrigeretion <br />Wo�dstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined this applicalion and Know the same tn be true and correct. Ali provisions oF laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or not. The grenting of a permit does not presume <br />to give authenry to violate or cancel the provision of any other state or local law regulating conslruction or the performance of <br />constr wn. Tha am aulhorized by Ihe owner of this property lo perform the work for which application is maCe and I comply with the <br />Stal Co Iraclor L w 18.27 RCW and 296.200 WAC. <br />� n .� � � � .� _�.)�u 2z �o� <br />