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P�2MIT APPLICATIO�J <br />CITY OF EVERETT PERMIT SER'✓ICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />/a � aa- -�c� <br />APPLICA710NS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8� CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />a, C�i S <br />LEGAI LOTNO. <br />DESC. <br />OWNER `/l� <br />% �� ✓� ! �� - <br />5� PARCEL TAX I.D. # <br />BLOCK TRACT <br />A��RESS CITY2IP P <br />�e�-�;es; � L � 8 %07 n�� � !7� �/ <br />PERMIT # <br />l��f lG - a�S <br />TENANT NAME CONTACT FOR PERMIT PHONE ��b � j" <br />-�r�'� -�r��� 20� �� ��G3 <br />CONTRACTOR � �" ADDRESS CITY2IP PHONE <br />�f � C —�c� N !� � aG(JrZ.'�t� <br />CONTR. LICENSE # <br />USE OF BUILDI�G <br />i c�C°/vl `�i�L � <br />WORK DESCRIPTION <br />NO, I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Backflow prevenler <br />Urinal <br />Orinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other _ <br />HEATSOURCE <br />_ Electric _ Gas _ Olher <br />CONTRACT PRICE OF WORK <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air syslems <br />Gas piping <br />W ater 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 />Woodstave <br />CITY OF EVERETT LOCAL SAIES 7AX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governin� this rype of work will be complied :ath whether specified herein or not. The granting of a permit does not presume <br />to give authority lo violate or cancel the provision of any ather state or local law regulating construction or the performance of <br />constructior. That I am authorized by lhe owner of this property to perform ihe �vork for which application is made and I comply witl� the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />�'����,,, ��/zz/ 5' <br />