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PERMIT APPLICATION <br />CITY UF EVIERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 6 CREDIT CO,RDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />�sz2 H�e��soa ,�,i <br />LEG LOT- 7NO. BLOCK <br />DESC. -C � S �� <br />VTjc� <br />TRACT <br />�� <br />PARCEL TAX I.D. t <br />sT <br />, 42s z r7 q„ <br />TENANT NAME I CONTACT FOR PERMIT PNONE <br />s'��`� w KF�cr�� T(JCKF/t �/2r 2s7 qS37 <br />CONTRACTOR AODRE88 �rtylLp pMONE <br />CONTR. LICENSE � <br />USE OF BUILDIN6 <br />HoM E <br />WORK DEbCRIPTION <br />HEATSOURCE <br />,� Electric _ Gas _ Other <br />CONTRACT PRICE Of WORI( <br />�a0oo.o0 <br />��PL/►C-F VJf�T£25E2VSCE FROi-t P'�ET�� TU F10uSL` <br />N0. � TYPE OF flIfTURE OR ITEM <br />Tailet <br />Bathtub <br />� Lavatory (wash basin) <br />Shower <br />Kitchen sink R disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbaqmop/etc.) <br />Badcflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other l�fEvr wqT�_ <br />P.FVE t" s�x F <br />NO. � TYPE OF fll(TURE OR ITEM <br />All: — eif h8n01ing uniffi <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplece <br />Gas renge <br />Clothes dryer <br />Renge hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigerallon <br />Woodstove <br />CITY OF EVCRETT LOCAL SALES TAI( CODE 18 J105 <br />I hereby ceritify that I have read and examined this application and know the same to be hue and corred. AII provislais of kws and <br />ordinaces goveming this type of work will be complied wRh whether specified herein or not. The granting at a pertnH doea not peeume <br />to give authority to violate or cancel the provision of eny other state or local law reguleting construction or the perfprma�ce o{ <br />constrvdion. That I am autiiorized by the owner of this property to peAorm the worlc for which application is made and 1 cromply wRh lhe <br />State Contradors Law 1 27 RCW and 296.200 WAC. <br />�(� - �t,��- 2 /is'lo r <br />Signature of OwnedContractoqAuthonzed Ageut ate <br />