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SITE ADDRESS --� � <br />/�� <br />LEGAL LOT NO. <br />DESC. <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 —wvw�.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 RM TO 4 PM <br />L�r✓.� �/ <br />I BLOCK <br />�RCEL TAX I.D. # <br />-o�/-a�a- <br />TRACT OR SUBDIVISION # <br />c5 <br />1 = ' �>' �(� <br />PERMIT # <br />Q��_� <br />����Fr� f�o��li�� ����f/��ii y 3i�� � C'ocBY�d= 9�?� i' Yzf 30 3. /i2/ <br />7ENA�T NAME CONTACT FOR PERMIT PHONE�- p „ <br />��INE� �ON ��C� � �EMAIL Od ,(� -��O <br />CONTRACTOR ADDRESS ITYIZIP PHONE <br />c� /�E/�E�� yO�.i�/.'vC flU�rHD�P/'T�� <br />CONTR. LICENSE # <br />USE OF BUILDi4G <br />J /`� �' <br />WORK DESCRIPTION <br />HEAT SQk1RCE <br />Eledric � Gas _ Other <br />COtlTRACT PRICE OF WORK <br />i�,����v, �1z� <br />,�'�`'�i`'��'-E"/'%�'G�L ��/sTi�/� - �.�F 4Tf/E,�i Z ATi� �n/ <br />NO. I TYPE OF FInTUR[ OR ITEM <br />Toilet <br />o��nw� <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Wale� heater <br />Sink (service/badmop/e�c.) <br />BackOow preven�er <br />Urinal <br />Drinkin� Founlain <br />Floor drain <br />Grease �rap <br />Roof dr�ins <br />Olher_ _ <br />Nt�. <br />Mt�„ <br />TYPE OF fIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas pipi�g <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pu,np <br />Unil hea�e! <br />Doiler <br />Refrigeralion <br />Woodslove <br />Olher <br />CITY OF EVERC-TT LOCAL SALFS TAX CODE IS 3105 <br />I hereby certify �hat I have read and examined ihis applicalien and know ihe same to be true and correct. All provisions of laws and <br />ordinances goveming �his lype o� work will be complied wi�h whether specified herein or noL The granling o( a permit does not presume <br />to give aulhorily to violate or cancel ihe provision of any other slale or local law regulating construction or the peAormance of <br />construclion. That I am authorized by ihe owner of �his property �o perform the work for which application is made and I comply with �he <br />Slate Cont � o Law '827 RCW and 29620U WAC. <br />/� n <br />� /,� �� -�-�� <br />Sig ature of iei/CuntractodAu(horizrd Agenl Date �f L <br />