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P�r�MIT APPLICATIG�J <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 ACCEPTEJ FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT AGCEPTED <br />31 E ADDRESS <br />U <br />L GAL LOT NO. <br />DESC. <br />OWNER <br />IM�ck��l <br />CONiRACTOR <br />yln A(l�tic U � �,J <br />�n �� <br />BLOCK <br />l�,l ES�-�c�^�( <br />1 PARCEL TAX I.D. # PERMIT ii <br />�� <br />r �U, <br />TRACT <br />A�DRESS CITY2IP PHONE <br />'�(o�L�' �jY\�t�c9 ►�r,� �`'�' <br />y� CONTACT FOR PERMIT c/ r (y- PHONE <br />1\ii1l`C� ( i �l � I� `—t �� S QQ La�O <br />CONTR. LICENSE p S � � � <br />USE OF BUILDING <br />�2�LS � C��r�-�-�' <br />�_ <br />ADDRESS CITY2IP <br />— tIEAT SOURCE I <br />Eleclric Gas Olher <br />WnRK DESCRIPTION _ � ��Sl ��� <br />`1��.c` G-�--a' ,� '�O <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Dathlub <br />Lavatory (w�sh basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service'bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof dr2ins <br />Other <br />PHONE <br />CONTRACT PRIC OF WORK <br />j�y�p� 4'� I r� t..�-� �4S °=' <br />NO. I TYPE OF FIXTURE OR ITEM <br />_� A/C — air handling units <br />Forced air syslems <br />Gas pipinc� <br />Water heater <br />Gas fireplace <br />Gasrango <br />Clolhes dryer <br />Range hood <br />Exhaust tan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces goveming Ihis type of work will be complied with whelher specified herein or not. The granting of a permit does not presume <br />to c�ive aulhonly lo violate or cancel lhe provision ol any other state or local law regulatinc� c struction or lhe per(ormance of <br />construction. Thal I am authorized by th ner of this property to periorm lhe work f ich appiication is made and I compiy with lhe <br />Sl�te Contradors Law 1�7 R�0 WAC. "� � 1 O� <br />/1 �� 1 i ' i <br />