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P�RMIT APPLICATIGnI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org � ��` ��3 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPT�D <br />SITE ADDRESS <br />L07 NO. <br />TENANTNAME <br />CONTRi.CTOR <br />�'�\n�J I�iN�Cs i�9'�/S� <br />CONTR. LICErIse �v �1�� \I� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />PARCEL TN( I.D. N <br />BLOCN I TRACT <br />I CONTACT FOR PERMIT <br />�\h�.J �fJV4.J <br />ADDRESS <br />P.agx�I <br />�lFI��L <br />I HEATSOURCE <br />PERMIT N <br />�207 <br />PHONE <br />��zs �7Z 7�33 <br />CITY2IP PHONE <br />/Ylr.4z��� t��� 7iZ �8-33 <br />_ Ele:.lric _ Gas _ Other <br />CONTRACT PRICE OF WORK <br />YG�� <br />�-�, S�� � 9��C— J7�.� Cc� ,�.� �,, o.✓ <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />_ Kitchen sink 8 disposal <br />Dishwasher <br />Cbthes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preveNer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas renge <br />Clothes dryer <br />Range hood <br />Exhaust han <br />Heat pump <br />Unit heater <br />Boller <br />Refrigeratlon <br />Woodstove <br />CITY OF EVERETT LOCAL SAIES 7AX CODE IS 1105 <br />I hereby ceritify that 1 have read and examined this application and know the same tu be true and correct. All provisbns of laws and <br />ordinaces goveming this type of work will be complied with whather specified herein or not. The granting of a permit does not presume <br />to give authority to viola e or cancel lhe provision of any other state or local law regulating constructlon or the performance of <br />construction. T�a I,d�uthoyz�d,�y the owner of this property to perform the work for which applfca8on is made and I compty with the <br />Stale ContraFlofs Z'a 18.a�xR�v,i'aod 2sfi �nn wac <br />� 9/� <br />��L <br />