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P�rtMIT APPLICATIO�J <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8o CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />��05 Nol�r••.�c q„c. <br />LEG�L LOT NO. BLOCK <br />DESC. 2z 23� 24 (p <br />DWNER <br />xr�� �' gurb �lol+�.� <br />NAM� <br />CONTRA,CrTOR <br />� M' <br />CONTR. LICENSE # <br />USE OF BIIILDING <br />Res�d�n��a1 J� �� <br />PARCEL TAX I.D. # <br />oos49 aoo�o �z�o <br /># <br />I TRACT <br />Quaah t`nne Aol�ti��nn t. ��le�e�' <br />ADORESS CITY2IP PHONE <br />��� S F(ol6rootc qvc, Eve,rit µ?S •413 -8Y'F � <br />CONTACT FOR PERMIT <br />La.v� oy t�o,rb �{o �+4rw <br />ADDReSS <br />HEATSOURCE <br />� Electric %� Gas _ Other <br />WORK DESCRIPTION <br />2rlcj'�-��c n� i �-���-t2� <br />PLUM <br />NO. I TYPE OF FIXTURE OR ITEM <br />'1 Toilet <br />� Bathtub <br />� Lavatory (wash 6asin) <br />� Shower <br />_ Kitchen sink 8 disposal <br />Dishwasher <br />Clothes wasF sr <br />Laundry tiay <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CITY2IP <br />PHONE <br />y�S-y23- �y'f 2 <br />PHONE <br />CONTRACT PRICE OF WORK <br />a G�.�� _r���� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas Tireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 1105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and cortect. All provisions of laws and <br />ordinaces governing this type of work �.vill be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authonty to violate or cancel the provision of any other state or local law regulating construction or the performance ot <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply wilh the <br />State Contractors Lnv 18.27 RCW and 296.200 WAC. <br />100 S <br />'IZ <br />