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�v P�RMIT APPLICATI�,N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 0� `��,..Q � <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />LOT NO. <br />Tc'NANTNAME <br />;^ k.c:�^ � ��G(%Cf"y PARCEL TAX I.D. # <br />e �bk T�d. - Z � - y�! - ; <br />BLOCK TRACT . <br />- i ��tfari� Vrei,v � � <br />ADORESS <br />ri�c�� l('OSNG4' S�alr�fiaa�uS� 1C'd,#l� <br />I CONTACT FOR PERMIT <br />To �P� Nrrd <br />CONTR. LIC[NSE # <br />USE OF BUILDING <br />ADDRESS <br />HEAT SOURCE <br />_ Electric � Gas _ Other <br />?ERMIT # <br />�y-�,oZ � 5z�-�L <br />� C'ei1�r l��✓. y Za�so/ro5 <br />cirraiP PMONE C7Z 557• 7 <br />rssa�cualr 980Z7 <br />PHONE <br />�rq�n�tec7`S �z��36���6� <br />CITY2IP PHONE <br />�/CONTRACT PRICE OF WORK <br />�P' � I .LiW� ,C�l7 ` 1 <br />WORK DE CRIPTION ��b[,� S�'�^UG7 �O'�'t O f a- �O/ Y�$ �' ' <br />�i.(di,► Ctn-i $T � f lr Ci31 U ejc• �!or �% �tu <br />CofU��tJiS �iLu�{ �;*cS�S , a��i�Gla ft�/ �,�e i�rr/�ryve�� <br />NO, I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shawer <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/elc.) <br />Backflow prevenler <br />Urinal � <br />Drinking FoQnlain <br />Floor drain � <br />Grease trap <br />Roof draiPs � <br />Olher YiYU' W� <br />�,,,�'h•.• <br />'(�(�.t.L�PJ� �'�GC�. <br />;� /.�z,-�u�� St�+'��, <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Ex�eusl fan <br />Unit h <br />Boiler <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby ceriti(y lhat i have read and ezamined this application and know the same to be lrue and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied wilh whelher specified herein or not. The granting of a permit does not presume <br />to give authonly to violate or cancel the provision of any other state or local law regulating construclion or the oerformance of <br />construclion. That I am aulhorized by the owner o( lhis property to perform lhe work tor which application is maue and I comply with the <br />State C actors aw,18.27�CW and 296.200 WAC. <br />