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P�RMIT APPLICATI(.►N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.ora <br />AFPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS � PARCEL TAX I.D. # PERMIT # <br />3�02 ROC� 00�4• ���• BZl3loo �io - o�� <br />LEGA LOTt�O. BLOCK TRACT <br />oEs�. 3l �' 32 �Z� �v�eTT ��v � __ <br />SV�kN � C-�l��l Dh WfJ1� <br />TENANTNAME � <br />CONTRACTOR Q � ��� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />5 F� <br />3�OZ fZOCK • �V <br />CONTACT FOR PERMIT <br />KRlS�rN NaNyor� <br />ADDRESS CITY/ZIP <br />HEATSOURCE <br />_ Eleciric �Gas _ Other <br />WORK DESCRIPTION <br />�kDD 401 s�R . �T. Uv [ <br />NO. <br />PLUM <br />NPE OF FIXTURE OR ITEM <br />Toilel <br />6alhWb <br />Lava!ory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishw2sher <br />Clolhes washer <br />Laundry lray <br />Sink (service/badmop/elc.) <br />BackOow preventer <br />Urinal <br />Drinkinc� Fountain <br />Floor d!ain <br />Grease lrap <br />Roof drains <br />Olher <br />� � �ZS. 258• 4ob` <br />' PHONE <br />�?�i •?'l4•712q <br />PHONE <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />FVC - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Ranc�e hood <br />Exhaust fan <br />Heatpwnp <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woadslove <br />Other <br />CITY OF EVERETT LOCAL SALES T/UC CODE IS J105 <br />I hereby ceritify that I have read and examined this applicalion and know the same to be true and correcl. All provisions of laws and <br />ordinaces gover��ing Ihis type of work will be complied �vith whelher speci(ied herein or not. The granting of a permil does not presume <br />to �ive aulhonry lo violale or cancel the provision o( any other slate or local la�v regulaling wnslruction or the performance of <br />construclion. That I am aulhorized by the owner o( lhis property to perform the work for which applicalion is made and I comply with the <br />Stale Contractors l�a�v 18.27� RCW ar�� 296 200 WAC. <br />�'�' �%�% �I� <br />Dale <br />�� <br />