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P�RMIT 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 />�`-II�oS <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SI7E ADDRESS <br />LOTNO. � BLOCK <br />PARCEL TAX I.D. # <br />� oa <br />TRACT <br />G50"7-�0 <br />�ya..�.. crCur�.z �ss y6ai.P��A��c E.�uvY,uN9emJ yrs a�1-3y�L° <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />,�r�..�-- c C.�r�,ii ,�ois .��., 2ott eci/.r z�� Yz3-3906 <br />CONTRACTOR 0��� ADDRESS CITY2IP PHONE <br />S�Gci ���c�/�uw+�c ��...,✓,/ur� yezoJ N•�.: Yit ZY7 51�� <br />COIITR. LICENSE M <br />USE OF BUILDiNG <br />S,�SlP ��,1 <br />HEATSOURCE <br />_ Eleclric _ Gas _ Olher <br />cei/.' scC YZ! iS�= <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />7k �..�..+e w� cl. "sr�S...� a--`�/ .-.cP�w�tMc.tif e� .cX riii:y i"ce%�ry <br />/ / <br />Y4 .G.nrovn./ �-.nl d•'s/+�s...l �F S�oo � ureeer�i�e.+.-.� cci/�vl� <br />NO. I NPE OF FIXTURE OR ITEM <br />Toilel <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Cbthes washcr <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Backllow prevenler <br />Urinal <br />Drinkinc� Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Olhcr <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas pipin9 <br />Water heater <br />Gasfrepiace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />�oiler <br />Refrigeretion <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES T!U( CODE IS J105 <br />I hereby ceritily Ihal I have rcad and ezamined this applicalion anA know lhe same to be true and correct. All provisions of laws and <br />ordinaces governing Ihis type of work will be compliod wilh whether specified herein or not. The granting of a permit does noi presume <br />to rvve authonry lo violato or cancel the provision ol any other slate or local law regulating construction or the pedormance of <br />construction. That I am authorized by the owner of this property to pertomi the work for which application is made and I comply with the <br />Slale Conyet`�or;d.a�v 18.27 RCW and 296.200 WAC. <br />f�� <br />