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PtRMIT APPLICATIC,N <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 8 AM TO 4 PM <br />SITEADDRESS `r�'w m"`���rf u t <br />Ev�_2CC�',�R-, q��3 <br />LEGAL LOTNO. BLOCK <br />❑FSC. �7 Z <br />:li CL(�K gGti.11�i <br />(3eU N Ce �uS i. Tnic-° <br />QcLfrtl C.%NS 1, ��L <br />CONTR.UCENSEN gJLINLI 1C�� MF <br />USE OF BUILDING $��16CE j-qv�1l� <br />WORK DESCRIPTION <br />GUU v <br />���� <br />I�U� I�UT\ �Z.� <br />CONTACT FOR PERMIT <br />C�R�.( g�C.lr� <br />ADDRESS j'J, (bolc � Z � <br />�nwK��TC�, �Fl <br />�� o d� <br />HEAT SOURCE <br />_ Eleclric � Gas _ Olher <br />con�sT2.����oN or n�E�,•.� s��vc��� Fr�.Mi��( <br />�v>- l�`� . �� � <br />7oilet �1• <br />BathWb ; � � <br />Lavalory (wash basin)1� 1 � <br />Shower <br />Kitchen sink 8 disposal � <br />Dishwasher, <br />Clothes washer ; <br />Waterheater � <br />Sink (service/badmop/ota) <br />BackOow prevenlcr <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />corv i Kwc � rrc�ct ur wunn <br />�/�O� 000 <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />J_ Forced air systems <br />_� Gas piping <br />I Water heater <br />� Gas tirepiace � <br />J_ Gasrange <br />�_ Clolhes dryer <br />,,_ Range hood <br />� Exhausl fan � � � � <br />Heat pump <br />Unit hcaler <br />Boiler <br />Re(rigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined lhis application and know Uie same to be lrue and wrrect. All provisions of laws and <br />ordinaces goveming this lypo of work will be complied �vith whether specified herein or �ot. The c�rantiny of a permit does nol presume <br />to give authoriry to violale or cancel lhe provision of any other state or local law regulalinc� construclion or lhe performance of <br />construclion. Thal I am authorized by lhe owner ol ihis property to perform lhe work tor which application is made and I comply with iho <br />Stale Contraclors Law 18.27 RCW and 2�00 WAC. <br />._. _. , r <br />- ! '"` '; ��' _ 6-Z'�-v7 ��'. <br />SignaWre of OwnedContraclor/Authonzed Agenl Date -�l �?� �� /� <br />ll � � � , „'/-���� <br />