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� _ <br />PERMIT APPLICATION <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 & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TNC I.D. N PERMIT A <br />� 670o f��Mo�sew ,Qp St�/o3I C�128oy-'�-ol�--000� I x(1,0'7'Ob <br />LOT N0. <br />7ENANTNAME <br />BLOCK � iRACT <br />��e <br />CONTACT FOR PERMIT <br />PH NE <br />PHONE <br />�STFK- MAnIuFAc.rwz��J 2�1c I �ou� C�wro�( <br />CONTRACTORPr�DfESSio�kl �Cun�QE/15� j�/L,'°`�DRESS Pd gbX �0� CITY2IP PHONE <br />CONTR. LICENSEit ���F �� r �g D� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />C�MP`� T� <br />eA,e,��ns�l QSDI y y�S-333-y�S3 <br />F1EAT SOURCE I CONTRACT PRICE OF WURK <br />_ Electric Gas Other � f�� 7� 0 � <br />P�uNr3i�/� `•N� Tf�.�.vr �M��D,1sM�r— <br />NO. I TYPE OF FI%TURE OR ITEM <br />I oilet <br />Bathtub <br />Lavatory (wash hasin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <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 />NO. � TYPE OF FIXTURE OR ITEM <br />wc - air nanaiing units <br />Forced air systems <br />Gas pfping <br />Water heater <br />Gas fireplace <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 7N( CODE IS 3705 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or not. The grantlng of a pertnit does not presume <br />to give authority to vio�ate or cancet the provision of any other state or local law regulaGng constructlon or the perfortnance of <br />construction. That I am authorized by the owner of this property to pertorm the work for which applicadon is made and I comply with the <br />te Contracrors Law 18.27f�CW and 296.200 WAC. <br />.. �. ��`ti^.�-. VIGc I�C�S�O<.yT' 7^IS^iJY <br />