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SITE ADDRESS <br />:� 4� i � S, <br />LEGAL LOT NO. <br />DESC. <br />NAME <br />PERMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREtT, 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 />BLOCK <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />CONTACTFORPERMIT <br />PHONE <br />�/v1J– <br />G <br />E-MAII <br />AC R A D � <br />i�c -zlc��r�'. �, �j wCus�,�a,�� �f p <br />CONTR. LICENSE p � � �iQ / ( 3 �' U � ( J� � - <br />—�i-L�I J-F✓�CCv3L� 3C _ � uD�i <br />USE OF BUILDING <br />�E ,� � <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Eleclric � Gas _ Other f_�� 9� 3, O� <br />WORK DESCRIPTION <br />(L� r�uvZ r i��� 1c� I � (aus -%�: rla GC t l� �^' li <br />,Q.r,N� ��t.w (�a s F'r �Jr /1� y-rcntit <br />��l.C..I,C-Vr �iiJ lC���l�C(Gl..� U1CLtCI� %1iLcll=�� �il.�Z(�I s I UV� <br />✓ <br />NO. � TypE OF FI%TURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwashcr <br />Clothes washer <br />Waler healer <br />Sink (servicelbadmap/etc.) <br />�ack9ow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />NO. � TYPE OF FIxTURE OR ITEM <br />AIG - alr hantlling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil heater <br />Boiler <br />Relrigeration <br />Woodslove <br />Olher <br />CIN OF EVERETT LOCAL SALES TN( CUDE IS J105 <br />I hereby ceritify thal I have read and examined lhis application and know the same to be lrue and corr[;cL Ail provisions of laws and <br />ordinaces yoverning lhis rype of work will be complied wilh whelher specilied herein or not. The granling of a permit does not presume <br />lo give aWhonty to violale or c�ncel Ihe provision o( any olher s�ale or local law reoulaling conslruclion or the pertormance of <br />constructioa Thal I am authorized by lhe owner of lhis property to perform �he work tor which applicalion is made and I comply with the <br />Slale CoNraclors Lmv�1827 RCIN and 29fi.200 WAC. <br />