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PS�RMIT APPLICATIVN <br />CITY OF EVERETT �cRMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-25'7-8857 — www.everetiwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADD ESS I /`" <br />Hel bro�k <br />LEGA LOT NO. <br />A�e <br />BLOCK <br />TRACT <br />PARCEL TAX I.D. # <br />PERMIT # <br />ho'f �z - <br />UYVIVtK Nuurtcaa a.0 t�ur rn:,n.. y�S ���' <br />�.a�ry f 3«,-6 (.�o I�um y33o ly�l�� Str� NC (►lan�su;llv 6� 08 <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />3e� F jc�w� Land es %e�9 <br />CONTRACT7R �h� t � S' o.� <br />CONTR. LICENSE # A� e�- �,1 Q6 I �T <br />USE OF BUILDING <br />Res i aa.��� <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 />Dish�vasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />3 �6 S . g�-r��,:��}';�!? <br />17jv.ri�r�t'va �.A. <br />HEATSOURCE <br />� Electric _ Gas _ Other <br />PHONE <br />QIu.A <br />98233 <br />.ibv "� fi'7 ' <br />S z�4 <br />CONTRACT�RICE OF WORK <br />�'-�*ra 3ZQ,2 <br />TYPE OF FIXTURE OR ITEM <br />A1C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiier <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SAlES 7AX CODE IS 31Q5 <br />� hereby ceritify that I have read and examined this application and know the same to ba We and corcect. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The grenting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the perfortnance of <br />construction. That I am authorized by the owner of this property to perform the work for which applicaGon is made and I comply with the <br />State Contractors Law 1827 RCW and 296.200 WAC. <br />pe�.a� , aoo y <br />