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.rur�-�-���s ie:as FRo�: <br />ro:ia2s�s�ees� P.3 <br />PERMIT APPLICATIQ�i <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 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PAP <br />Z22lo �/l � �V1 C4.�-i"� (X�� <br />LEGA LOT NO. BLOCK TFiACT <br />DESG. <br />OWNER ADDRE55 <br />�.C�� &tr%/�e4�(X Z`2z<a � <br />L� �1S IR-f �-fit�/j � �, <br />CONTR. UCENSE �` , r���i� /` /'� <br />W W 7 <br />USE OF BUILDING <br />�' �C___ <br />CEL TA7C I.D. # PERMIT # <br />v /S47 �l�d o ti'Y105aCo- <br />ICONTACTPOF <br />u , • /� <br />� <br />�L �� <br />c� � vu. �. � Y.� ' <br />iy« 1�'-c �ua-�� 9�Za � <br />HEATSOURCE <br />,_ Electdc !� Gas _ Gther <br />rnvnc <br />CITY2IP PHONE <br />WORK DESCRIPTION �/v"�' �� � <br />9� � � � <br />NO. � TYPE OF FU(NRE OR ITEM <br />Toilel <br />6aNtub <br />Lavatory (wash basin) <br />Shower <br />IGtchen sink 8 disposal <br />Dishwasher <br />Ciothes washer <br />Lsundry tray <br />Sink (servicelbadmopletcJ <br />BackBow preventer <br />Unnai <br />Drinking Founlain <br />Floor drain <br />Greasc Irap <br />Root drains <br />Other <br />CONTRACT PRICE oF worcn <br />� �l � <br />NO. I 7YPE OF FIXTURE OR ITEM <br />AIC —air handling units <br />Forced air systems <br />Gas piFing <br />� Water hea!er <br />Gas fireplacr. <br />Gas rango <br />Clolhes dryer <br />Rango hood <br />E�austfan <br />Hoat pump <br />UNt heater <br />� Boiler <br />Refrigeraticn <br />Woodstove <br />Othcr <br />CI7Y OF EVERE77 LOCAL SALES 7AX CODE IS 1105 <br />I hereby ceritify Ihal I havo read and ezamined this appliwtion and know lhe same lo be we ard cortecl All provisions of laws and <br />ordinaces goveming ihis type of woik vnll be wmplieJ wilh whclher specified herein or nol. The yranting ol a permN does not presume <br />to give authonty to violato or cancel the provision of any other slate or local law regulating constructlon or Ihe pedortnance ot <br />construclion. That I am agu't$hor¢ed by lhe owner of lhls propory to perform ihe work for which applicallon Is maae and I comply wilh lhe <br />StalaCony�'torsn/ 'l V�� ,.'� .2oowP,C. ��3/Q� , l���O� , �,v <br />� T �� <br />