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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />/ 3200 CEDAR STREET, EVERETf, WA 9820t <br />�n j �,lL ����� �.'425- 57-8810 - FAX 425-257-8857 - www.everettwa.org � 2 — � � + � � <br />G� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SIYE ADDRESS <br />9i`VEF�•D��r B�-✓D�NoFLDFS�+ <br />LOTNO, � 9LOCK � TRACT <br />L TAX I.D. M 1 <br />1 ��3�?��'`1' <br />DESC.j I I <br />OWNER RESS CRY/IIP PMONE <br />1�c5 �vwP-,,,°�c++wtdvH�Shh RO <br />Tf'�cc fJ«�. � . /07 /ts�r1-�a�ONy vU�, �t2� r'�7•77�7 <br />TENANTNANE CON?ACTFORPERMR PHONE <br />/�l r.'",�. �2.iZh� l��vl�(-IrNG'�G�,�.�j-rflN�1-l�Y'+�S 4ZL� f��_- Hioo <br />CONTRACTORGJ�(��!� L, ((..{C:. ADDRESS6 ��%-�ia�AE��T1'21P PHONE4'L�'j.��jo�QJ <br />CONTR. UCENSE Y S�Gn�= �o99M a �' �a �`��� <br />USE OF BUILDIN6 <br />CGCViM FPL/.�(L <br />HEATSOURCE <br />EIecVIc _ Gas _ Olhar <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION (/�/S-�J� TW�J ' Z) '�Llit�� . NLi—/l��"f �ti%Tr S( Gh.G�j . <br />N0. I TYPEOFFU(TUREORITEM <br />Toilet <br />Balhlub <br />Lavotory (wash basin) <br />Shower <br />Kllchen slnk 8 disposal <br />Dishwashor <br />Clothes H�ashor <br />Leundry �rey <br />Sink (sorvice/ber/mop/etc.) <br />BeckAow preventer <br />Urinel <br />Drinking Founleln <br />Floor dreln <br />Greeso trap <br />Rooi drains <br />Olhar _ _ <br />N0. I TYPE OF FIXTURE OR ITEM <br />A!C — eir handlinp units <br />Forced nir systems <br />Gas piping <br />Water heater <br />Ges fireplaca <br />Gnsrengo <br />Clothes dryer <br />Ranga hood <br />Euhaustien <br />Heet pump <br />Unit heater <br />Boller <br />Refigeralion <br />Woodstove <br />CITY OF EVEREIT LOCAL 9ALES SA%CODE IS 3105 <br />I hereby contify thnt I have road end exomined lhis appllcedon end know lha same to be true end correct. Ail provisions of laws and <br />orciinaces governing this type of work will be complled with whalher specifled he�ein or not. The granting of a permit does not presume <br />to glvo nulhonty lo viotale or cencel the provision of eny other stele or local lew regulaling construction or the pedormenco ot <br />co truction. That I am aulhorized by the owner of this propurty to perform the work for which application is mede and I comply wilh the <br />Slete nVactws Lev�18.27 RCW end 298.200 WAC. <br />� <br />