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SITE ADDRESS <br />. .i <br />LOT NO. <br />D[SC. <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 9 AM i Q 4 PM <br />BLOCK <br />L <br />TRACT <br />PARCEL TAX I.D. # <br />� � �3 -06 <br />�� <br />PERMIT # <br />��� <br />TENAN'I' NAME I CONTACT FOR PERMIT PHONE <br />' / / I/ �- 2 <br />��C� '' /V l (<� f-ti'f�l /[� .�-�i: �o�'J-/�i/�-� <br />CONTRACTOR/ ��Sv✓,C.��n ADDRESS CITY121P PHO�E <br />�'� � �7'i 5 GcH,ciavLJt S�k'*�C /4'F1'7�I J6-�.:-5-45�'J <br />CONTR. LICENSE p/`� �-7 y/- �� G f� <br />l., f=(� '! 7 <br />USE OF BUILDING <br />G"` •�q` <br />tn/ I <br />HEAT SOURCE I C�TRACT PRICE OF WORK <br />Electric '� Gas Other �. (/ ��`'�`� <br />WORK DESCRIPTION � � <br />�v�7-�0. l I O�� L�,tiiv�w. � cct ( �ci f-�G.,M l�/t-c 'l �T✓'zc�v� Hoa C�� ��, � <br />�)' �.e e�lii cw'7 r tc+�v� � J�'l.� /l�G� I�.c v� t� �✓� C� L ��G f' I/✓ ;) ✓�� <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbadmop/etc. ) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I NPE OF FIXTURE OR ITEM <br />A/C - 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 />Exhausl (an <br />Heatpump <br />Unit heater <br />Boiler <br />Re(rigeration <br />Woodstov,e � v .✓ <br />Other ;L{ <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 7105 <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 />ordmaces goveming this type of work will be complied with whether specified herein or not. The granling of a pertnit does not presume <br />to give authority ro violate or cancet the provision of any olher slate or local law regulaling construction or the periormance of <br />construction..Tfiat I am aulhorized by the o�vner of this property to perform the work for which application is made and I comply �vith the <br />,.._._ ,..-'---'--- �_.... o o� r�r�w�_...a ooa �nn �nrer <br />