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PcRMIT APPLICATI(.,nl <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.ory <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />� ' �) , <br />��/. '�C�%l/L^ <br />LEGAL ^ lOTNO. BLOCK <br />DESC. <br />wrvn< i / � / <br />Y��/i�i�'�,/li,�: `/i%�l= �Qr�%1 <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION N <br />PERMIT # <br />' � � `,9 . <br />�,u� �'.e ����� C�r,�, l�• G <br />� <br />TEN� nryT ryqME ' CONTACT FOR PERMIT PHONE <br />E•MAIL <br />CONTRACTOR , • I, �,,,, _. ADDR S (� CITY/ZIP PN NE <br />��r�/; f'�.�:�� �q :.:,_- j✓`"C`/��/L� �l-�'c-%' �F.11l1 ly,!!1- 'l5/C % 10GG3j�/�/� <br />CONTR. LICENSEiI������� /J�S,/ J �Z� � � <br />� �� � <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. I TYPE OF RXTURE OR ITEId <br />Toilet <br />Bathlub <br />Lavalory (wash basin) . <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/barhnoplelc.) <br />8ack(low prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease Irap <br />Roo( drains <br />- ou,�� =.c���� ,../ln.� ��,���„t�� <br />HEATSOURCE <br />Eleclric Gas Oiher <br />/.t f!'•z �a:.s'/ `�r <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A�C - air handling units <br />Forced air syslems <br />Gas piping <br />Water healer <br />Gas lireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exh�usl fan <br />Hcal pump <br />Unil h�ater <br />Boiler <br />Refrigeralion <br />Woodsto�e <br />Olher <br />CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify thal I have read and examined lhis applicalion and know the same to be true and correct. All provisions of laws and <br />ordinaces c�overninc� this type o( work will b� complied with whether sp�ci(ied herein or nol The gianting of a permit does not presume <br />to give aulhority to violate or cance' lhe provision of any other state or local law regulating conslruction or the performance o( <br />consiruction. That I am authorized by the owner of this property Ic pertcrm lhe �rork fc� ��+hich application is made and I comply wilh the <br />State C �ntraGlors Law 1827 RCW and 296.200 WAC. <br />, �. - �� ,;i 4 t" � �- � - U c <br />,.. .. -- -...__--'^--`-..,_.,n..u._..._,.a n.....,. neta <br />r � J <br />