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c <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — vwvw.everettwa.org <br />APPL(CATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. N P RMIT M <br />;�qal NAss�� ST I ao�3�l�7S0/2op �5��-c>> <br />LEGA LOT NO. BLOCK TRACT <br />DESC. j`� (o�g nuf oF EVE,=crT� bt✓• G, ��� 3, �� '� <br />i�qnl MONT�ll"ff <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE f <br />OWN6R. <br />USE OF BUILDING <br />5, f. R�S��eN-flAl� <br />li8' PQrf�; paNr A+L n�ul ,�frc�a�rP, <br />ICONTACT FOR PERMIT <br />Dq,�/ ,MJN'r� �TH <br />ADDRESS <br />HEATSOURCE <br />Electric ✓ Gas _ Olher <br />WORKDESCRIPTION �'£P�.Aci. 'RoTTip SNPjvcf <br />,�/p� _ SsAF�NG- I� �£2i C�L u�4�c. + q �il pJL <br />S/�£�filociG INf£A-lof CG NO�iS�� ti£Gthc�i <br />-�So-�3o,p <br />PNONE <br />ULS-7So-73op <br />CITY2IP PHONE <br />CONTRACT PRICE OF WORK <br />X i Z. J�' � <br />pl5r5 /N LRAKJL S��}c�� F£Mo✓£. ��✓� <br />Nc�N-.Bb4GNGr n�+�� �'u� ec-cc�i75 <br />iN74,2�oF Dool1S tTRiM '� �:4Ci�n�=YS� <br />�PL4C£, �LDD�- �J��'-IA%CrS� R£PInCL 3'1CK EXT£R�oiC.. �jt � z�._ P�uMa F/Ou S£. <br />NO. I TYPEOFFIXTUREORITEM <br />i Toilet <br />� Bathtub <br />i Lavatory (wash basin) <br />� Shower <br />� Kitchen sink 8 disposal <br />f Dishwasher <br />I Clothes washer <br />Laundry lray <br />Sink (servicelbarlmopletc.) <br />Backflow preventer <br />�!rinal <br />� Drinking Fountain <br />Floor drain <br />Grease trap <br />Root drains <br />Other <br />� Ho5[� � a�AS--- <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler heeter <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaust(an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7IU( CODE IS J706 <br />I hereby ceritify thal I have read and examined this application and know the same to be We and corted. All provisions af laws end <br />ordinaces goveming this lype of work will be complied with whether specified herein or not. The granting of a pertnil does not presume <br />to give authority to violate or cancel the provision of any olher stale or local law regulating construction or the perfomiance of <br />wnstrudion. That I am aulhorized by the owner of ihis property lo pertortn the work for which application is made and I comply with the <br />State Cq�tredors Law 1827 RCW and 296.200 WAC. <br />J`%,� _ '�/1/l ,,.-f_:.�t/ � - I � - oS' <br />