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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 <br />SITE ADDRESS <br />7Ho') c.1� -�S� ;� c ( � �'4' l <br />LEGAL LOTNO. BLOCK TRACT <br />DESC � <br />PARCEL TA% I.D. # <br />-.�3T�1-0� <br />—� ..I�j��10 <br />PERMIT # ., � <br />il���;(..���� —{,� � <br />- 775(-- "l`���z <br />TENA NAME CONTACT FOR PERMIT PHONE <br />�ic�� ��,�c- � � � �� 7, �-�� -6g'r /�-I /�/ <br />CONTRACTOR � ��r ADDRE55 CIN21P PHONE <br />LT rut r 5� � C • � � . y� ,; 5 . G�,,,.,�.�.,.5r � �,-. �./4Yl 3 �i d-.x. --3�- � -�o.� ; <br />CONTR.LICENSE# /��F�. � s���r��Z <br />L <br />USE OF BUILDING <br />�t,�j�i.l%6 <br />— HEAT SOURCE I C� RACT PRICE OF WORK <br />Electric /� Gas _ Olher � � � � <br />WORK DESCRIPTION ' <br />�, s rr� ( I o,,,� Ca, ��,� �, c �v( Kr�-Gl� 7Y �` <br />,��� e�l�cw�i� �C•�� .�:L� vt��ti�� VA ,�"�/ <br />NO. <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen smk 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicePoar/mopletc.) <br />Backflow preventer <br />Unnal <br />Dnnking Fountain <br />Floor dram <br />Grease trap <br />Roof drains <br />Other <br />f-/� �� � � <br />v� �� r�� �� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/G — air hantlling uNts <br />Po�ced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas renge <br />Clolhes dryer <br />� Range hood <br />�_ Exhaust fan <br />_ Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />�woodstove � �f �i �• <br />Other ,ti1r. <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritity that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br />ordmaces governing this type of work will be complied with whether specified herein or not. The granting of a pertnit does not presume <br />to give authonty ro violate or cancel the provision of any other state or local law regulating construclion or the performance of <br />construdion. That I am authorized by the owner of this property to perform the wurk for which apphcation is made and I comply wdh the <br />State Co tr rs Law + and 296200 WAC. /�/ <br />� ,� / �l� <br />��� <br />