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PEr2MIT APPLICATIOi� <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 />� <br />� �p -��-� � <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />=vc2�,T�ac��- <br />LOT N0. BLOCK <br />DESC. <br />TENANTNAME <br />PARCEL TAX I.D. # <br />TRACT <br />CONTACT FOR PERMIT <br />CONTRACTOR / �9 ADDRESS CITY2IP <br />/�c? r Perso.��..00'mosl'rue7r c, � .>.��=v �v[a� n/��+,�/o[.4s er h' <br />CONTR.LICENSE# �C,2%��C�O/S`�U //�/�L <br />USE OF BUILDING <br />HEATSOURCE <br />Electric Gas Olher <br />WORI( DESCRIPTION � � _ <br />� fC'hc�ii �v'voI �a, .. <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower - <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mopletc.) <br />� Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />=I Other <br />� <br />PE MI�jG,� <br />PHONE <br />PHONE C� 1�6r7-3Y �i <br />�.ev O� �7i�-3 / <br />� <br />PRIC'c OF WORK <br />,,z_ <br />O [*� <br />NO. I TYPE OF FIXTURE OR IT[M <br />AJC — air h2ndling unils <br />Forced air systems <br />+ Gas piping <br />Water healer <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 EVERETT LOCAL SALES 7AX GODE IS 3'f 05 <br />I hereby ceritiy that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or rot. The granti�g cf a permit does not presume <br />lo give authonty to violate or cancel the provision of a�y other state or local law regulating construction cr the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. , <br />/' D/�- �/O <br />