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PEr2MIT APPL�CATIO`nl <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 />C�� � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS :�;.L�� PARCEL TAX I.D. # <br />' � L�w� g� /'�•�� .�c. �l-373 d8d�l 3ooc� 1 <br />LEGAL LOT NO. ry�BL/�O�CK /� RpA�CT OR SUBDIVISION # y� <br />DESC. I����� T.7CJ� \Li�rl D{'� t�I�C�Q�I � �IU 'L <br />n��lU1�' �:LL. �p� 2 <br />NAME <br />�N L <br />CONTR.LICENSE��`�v� �a77Q' <br />'�� �?f' ,IJt / W-;�J%1�c1�U ��L23 <br />CONTACT FOR PERMIT PHONE <br />v%r�L�N � <br />USE OF BUILDING HEAT SOURCE <br />u'1lA�h F-a+^� /�� �> �T�R'L �+ <br />_ Eleclric / \Gas __ Olher <br />�Z"��`-07 <br />PERMIT # <br />I�io�t — 6o�i3 <br />�q - G o37 <br />E.MAIL C�i��Z��i�Aitvc. <br />PH�NE—� <br />�s-��-�s3Z <br />CONTRACT PRICE OF WORK <br />LJ <br />`c�, c�c�0 <br />WORKDESCRIPTION �t.�� ��:TKAt'ta� `2� C�Rr"�y5"�:n�'C���+_ 3u��i� Ch= Z�A�CV� <br />�nlCc.�h�� :�P-0un,� waZ�� yt�u� �LtvuKuPSi �1�Dh�'�on� i F�,4,nn�.a,to� �ev=i�, l}nCY��'�/(/k� <br />T�U,w�Pi��vlc � �=�t-c.�e��nt � ��U�h+"IvC ���Fi1D�^i-c ur h'�,St+ . �q vJS� �c /rv.J k�f �i �'h:-.2 <br />�-ftT7rizl�iC�V1ci-S �_�O�^PlL1C. <br />ne�runnurei <br />NO. � ?YPE OF FU:TURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Back(low prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Other _ <br />NO. I TYPE OF FIXTURE O� ITEM <br />A/C - air handlinc� units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodslove <br />Other CT.��t �"-G i� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify lhat I have re3d and examined this application and kno�v lhe same lo be lrue and correct. All provisions of laws and <br />ordinaces governing this lype o( work will be complied wilh whether specified herein or not. The granting of a permit does not prasume <br />to give authorily lo violate or ncel the provision of any o;{ier stale or Iocal law regulating construction or the performance o( <br />construcli . That I am aut or ed by the owner o( fhis property to perform lhe vrork for which application is made and � comply wilh lhe <br />S!ale C ctors Law 7 CW and 296.200 WAC. <br />n. �-i ,�' _ il�� Io > <br />��� <br />