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�inn <br />� .�-�"' �� PERMIT AFPLICATIO�I � <br />c�G tirG�n <br />L" CITY OF EVERETT r'ERMIT SERVICES <br />O"`i�`� ��y 3200 CED{�,R S'rREET, EVERETT, WA y8201 <br />425-257-8810 - FAX 425-257-8857 - vNN�.everethva.org <br />� APPLICATIONS qRE ACCEP7ED FROM 8 AM TO 4 PM <br />SITE A�DRESS <br />�' (o .� O�lo <br />LEGAL LUT NO, <br />GESC. <br />BLOC:< <br />fJ0.=>5 ���va.%��. <br />PARCEL TFJC I.D. it <br />TRACT <br />�d . � GX �' g�G �Ue�et1 <br />PERMIT N <br />—U3� <br />TENANT NA1dE I CONTACT FOR PERMI7 pHONE <br />��ar•��oass 7�/�ci�/ . S �)e�11�- 5��� - 3�/9- Q',�/3 <br />__ eo_,� <br />CONTRACTOR ADDRE55 CITY2IP PHON[ <br />CaJG'�'�rn /�1oo�nq '�'�rcJiCe 49�/0 /7(�t��IuNNE /'L��"- <br />CONTR.LICENSEl1 ✓ <br />USE OF eUILDING <br />,�on4 _ f��n1 �ai�'–� <br />—J <br />WORK DESCRIPTION <br />�9�rS a '� <br />!�/..e�t. r <br />���r/i M�2i <br />NO. <br />��' — <br />/�ca'mcnd 88/-�J /�i O <br />9�0�� <br />HEATSOURCE <br />_, Electric _ Gns _ Other <br />CON7RACT PRICE oF WORK <br />/�J, i9S.00 <br />' M o✓c �.x iC,.�i n'q/ r.�o � i/�1qJ � �4 n 3?''a_ l l '-l-Cc�� <br />�� i��Ch �%e:r�30�r'e{ 'ri'1cY'/�t�.ry�C0..�/ �2fdc^�j�. 1n3fQ// <br />�spha/;� `�c�s�m; �n�-zai/ �X�j v��.i.��J 2t <br />cJJ � `/�-�ctl �'"O :n G o /'oa� /7X.(/'Ic <br />PLUMBING MECH ICAL <br />NPE OF FIXTURE OR ITEM N0. I TYpE OF FIXTURE OR ITEM <br />Toliet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen cink 3 disposal <br />�ish�vasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mopJetc.) <br />BackFlow prevent=r <br />Udral <br />Drinking Fauntaln <br />Floor drain <br />Grease irap <br />Roof drain5 <br />Otner <br />NC – air handling units <br />_ Forcedairsystems <br />Gas p;cing <br />4Va:ar healer <br />GBs i�repl�ce <br />' Gas range <br />Clatheb dryer <br />Range hood <br />� Exhaus;fan <br />� Heat pump <br />` UNt heater <br />8oiler <br />� Refriperaticn <br />,� Woadslove <br />O;her__ <br />CI7Y OF EVERETT LOCAL SALES 7AX CODE IS 3106 <br />I hereby ceritify that I have reatl and ezamined tnis applicatior, and know the same to be Irue and ca�rect. All provisions of laws and <br />ortlinaces goveming thls type o(work will be complied with whether specifeq herein or nm. The granling of a pertnil does not presume <br />to give authority to violate or cancel the provision of any other state or ioral la�.v reguiating construction or the performance of <br />construct' n, That I am a thorized by the owner et this proper,y tn pedortn ihe work tor which apptica(ion is made and I comply with the <br />Stat2 C�r�ctor5 Layr�J,27 RCW gctd 296.2001NqC. <br />