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PERI�iIT APPLICATIuN <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 />SITE ADDFESS <br />/5nc .s._= E���,�r�rr.a« 4 �y, <br />LOTNO. � BLOCK <br />�„ �i�y ��oi� �ss��. <<< <br />PARCEL TAX I.D. # <br />2,S�o 51 �oC��fD I1DO <br />TRACT OR SUBDIVISION # . <br />/U/(� St" Er-��r i! si.ltc l.��Y C!/�.�'/.=iT <br />CONTACT/ FOR PERMI7 <br />�)AG,/l�o.� ���� �� p.t <br />c�AiiFA�TO� ^` <br />�a�r�-..,,�t�d F,�� /���l�ca,�,, v v. <br />CONTR. LICENSE 31 �/)(, �:��Y'jP/% %13 G <br />USE OF BUILDING <br />ia—a-5—� <br />KlolO-o�2 <br />PERMIT # <br />n�n,�)� <br />'HONE <br />!j$�E�O�-O%00 <br />rn�n� l�lS�!%6J"J(+S� <br />E-MAIL 11r1�1�O.7ErG�����P��e�� <br />q�Ri <br />/S�3 -...._.. l..y..ld <br />���v�l�n✓�ile WA �18��1 IZ � I 3�S6S7 <br />HEAT SOURCE <br />_ Elecldc _ Gas _ Other <br />WORK DESCRIPTION <br />I�s���.N ��ew F�•,,�Jeu-1 hea�'s i,iav �Na- Jr��l Ce,l,,,� <br />.sYs�l���ri d�s,�ne�l ��E;, tir-�,a .3. <br />, <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen slnk & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mopletc.) <br />BackTlov: prevenler <br />Urinal <br />D�inking Founla(n <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />CONTRACT PRICE OF WOKK <br />�j'2 /O U <br />l/Oy"1 An C'x�S-iu�, <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — air handiing units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heeter <br />Bolier <br />Refrigeratlon <br />Woodslove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby cerilify that I have read and exam(ned this appifcation and know the same to be true and correcl. AI� provisions of laws and <br />ordinaces governing this lype of work will be complied ��+ilh whelhGr spec�ed herein or noL The granting of a permit does not presume <br />lo give authorily lo violale or cancel lhe provision of any other slale or tocal lavr regulaUng construclion or the periortnance of <br />conslruction. That I am aulhorized by the owner of lhis property to per(orm the work (or which appiication is made and I comply with lhe <br />Slale Conlraclors Law 18.27 RCW and 296.200 WAC. <br />,�/�o.�� %(,�/r`c,-1 <br />!G'- 21-/O <br />