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P�RMIT APPLICATI�.�� <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 />D� �a�-3g <br />1 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 3 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />�Dl�c r � <br />LEGA L0T NO. <br />DESC. / <br />OWNER <br />1�1Qr�► S c o-� �: - <br />TENANTNAME <br />COri�FtA�CTOR 1 <br />��W`� SCJky <br />CONTR. LICENSE N <br />USE OF BUILDING <br />SFR <br />PARCEL TAX I.D. M I PERMIT / <br />�o � . �. <br />BLOCK TRACT <br />� ,a�� - ooa- oU� <br />ADDRESS CITY2IP PHON <br />Qr`s� UU�h�'J LP�C. (o�o I�-I�-=' �[, sE �cr <br />Co nsi�uc�i or� <br />IQ� M <br />CONTACT FOR PE�� f� PHONE <br />La2,..+ S� Y35 - 3�/'/ � 455fo <br />ADDRESS CITY2IP PHONE <br />(,�(o t47-=° ��— s E '�%1S - 39� <br />Evt�c-M wo. 9 $�08 965� <br />��- � 3 - � <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Electric �: Gas _ Olher � � � 8.�� ' dV <br />WORK DESCRIPTION <br />N2� SFCL Cus {-w.ti , 19 -1-► <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet %�! <br />Bathtub'1 <br />Lavatory (wash basin)///i <br />Shower ! <br />Kitchen sink 8 disposai <br />Dishwasher <br />Clothes washer <br />Laundry lray <br />Sink (service/bar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Olher <br />ScD ,.2 . S N3 a-r- H��j Cr►R . <br />TYPE OF FD(TURE OR 17EM <br />AIC — air handling unils <br />Forced air systems <br />Gas piping ✓ <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan F/f� <br />Heat pump <br />Un(t heater <br />Boiler <br />Refrige2tlon <br />Woodstove <br />Other _ <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 9105 <br />i hereby ceritify that I have read and examined this appiication and know the same to be true and correct. All provislons of laws and <br />ordinaces governing this type of work will be complied with whether speciTied herefn or not. The granting of a permil does not presume <br />to give aulhority to violate or cancel the provision of any olher state or f�cal law regula6ng constructlon or the periormance of <br />construction. That I am authorized by the owner of this property to perfortn the work for which applicadon is made and I comply with the <br />Stale Cor�kaclors Law 1,6'27 RCW%nd 2962D0 WA�. <br />l/ <br />L 31 �9 S �L <br />