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SIl"E ADDRESS <br />� -7 c� � <br />_r <br />LEGl� LOT NO. <br />DESC. <br />��,� , l� , �.�. <br />PERMIT APPLICATION <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 />Weca v;� <br />BLOCK <br />v�,�� s <br />PARCEL TAX I.G. # <br />��TftAI:T OR SUBDIVISION # <br />�-I-� oy � <br />TENANT NAME CONTACT FOR PERMIT <br />E-MAIL <br />NTR .TOR ADDRESS CIT IZIP PH E <br />pERMIT # <br />!� idU�� <br />Nnont y z S- z 5 I- <br />t�eu-� � �i kZc� 3 z'12� <br />PHONE <br />CONTR. LIC[NSE M <br />USE OF BUILDING <br />C�w� <br />HEATSOURCE <br />✓ Elecinc '�Gas!�Olher <br />WORK DESCRIPTION /j 1 ��4�.�� -} � � <br />�,.,��. , �n ������.,,�, r����w�� <br />c��� �f��,�. � s � P,v� Qo _���Qi�.�.� <br />G.--�� ��1.. I.-�. n-.�� ;�-. i�..� i L�_..� <br />ryp, I TYPE Of FIXTURE OR ITEM <br />Toi�et <br />OalhWb <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Waler heater <br />Sink (serviceNadmopletcJ <br />Backilow prevenler <br />Uri�al <br />Urinking Founlain <br />Floor drain <br />Grease �rap <br />Rouf drains <br />Other <br />CONTRACT PRICE OF WORK <br />wl w�cv a�l u��Vtic exa..,.r-� �';,,,�( <br />� ,�..,.. � , �� o� %..- o u �-- V' e � � ��..,.�.., �< <br />�\+�w�A.� V�AS ��"CA�..lX 4h0.1-1 J-a.iv.L�U�n.�n. �rtJ`�. <br />6 <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />�orced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas renge <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Neat pump <br />Unit healer <br />Ooiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVENETT LOCAL SALES TAX CO�E IS 3105 <br />I hereby certi(y Ihat I have read and examined Ihis application and know the same to be irue and correr.t. All provisions of laws and <br />ordinances governing �his lype of work vill bc wmplied �vilh whether specified herein or not. The yranbng of a permit doe�� nol presume <br />�o give au�horily to violate or cancel the�rovision of any other stale or local law regulating consiruction or Ihe performance of <br />construclion. Th�l I am aulhor¢ed by llie owner of this prope�ty lo peiiorm the work for which application is made and I compty with ihe <br />Stale Conlraclors Laiv'�27 RCW and 296,ZD0 WAC. <br />/ <br />� 1�, i�I1„.. �/���/V <br />naWre <br />��L- <br />