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P�E�MIT APPLICATI�N <br />CITY OF' EVERF_TT PERMI'� SERVICES <br />320fJ CEDAR STREET, EVERETT, WA 98201 <br />425-257-f3810 — FAX 425-257-8857 -- www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />�'B-D s� � VEi� I i M��( �Na��r <br />LEGA LOTNO. <br />DESC. <br />OWNER ��zog//�%S�y� <br />TENANT NAME <br />CONTRACTOR S ��.'��I <br />H -G <br />CONTR. LICENSE # <br />SiA'�M' <br />USE OF BUILDING <br />WORK DESCRIPTION <br />BLOCK <br />'�(20+rJ�11� <br />PARCEL TAX I.D. # <br />TRACT <br />CONTACT FOR PERMIT <br />z�Nlj L{` ADDRESS CITY2IP <br />� �a�3 r �� t�v� � • <br />�I��%�✓ 5�--{-fls. I.t%a `�`d f`�- 4- <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbadmopletc.) <br />BackFlow preventer <br />Urinal <br />Drinking Fountain <br />Fioor drain <br />Grease trap <br />P.00f drains <br />Other <br />w�� - � �, <br />G ot'(ati . <br />HEATSOURCE <br />Electric Gas Other <br />� <br />PF.RMIT iF <br />PHONE <br />PHONE <br />�r�b �/R - 7� ¢� <br />CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A!C — air handling wiits <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETI' LOCAL SALES 7AX CODE IS 3105 <br />I hereby ceritify that I have read and examined this appliceiion and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied v�ith whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other stale or local law regulating construction or thP performance of <br />construction. That I am authorized by lhe owner of lhis property to perform the work for which applicaBon is made and I comply wilh lhe <br />State Contrectors Law 18.27 RCW e^.c: 296.200 WAC. <br />.7� � �/� ¢ <br />