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PCRMIT APPLICATIVN <br />CITY OF EVER�TT 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 (+�. �-O�J <br />/ <br />S�TE ADDRESS PARCEL TAX I.D. p P RMIT N <br />50� ,eu�eR Av� � � �� �-oa, <br />LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION ll <br />�ESC. <br />OWNER ADDRESS CITYIZIP PHONE � J' <br />f���l?le �_, l��lc%rem�,'� 5olq �vcke� l#+� f�1t,�vA 9a�3 �a9-�3 <br />r <br />CONTR. LICENSE p (, �<%h�C'��— <br />USE OF BUILDING <br />q,)�,�- cR�,: /+,��, E �k n <br />S.,4G� 1=���,�- ,�ES/�J`-..✓�u= <br />WORK DESCRIPTION <br />���� t <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Dalhlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />\Nater hrater <br />Sink (service/badmoplelc.� <br />�ack(low preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease Irap <br />Rool drains <br />Olher <br />CONTACTFOR <br />�%V1 C!.3 <br />HEATSOURCE <br />Elec�ric Gas Othcr <br />PHONE <br />l l•' 1 7 r} % <br />L1/ 3 I .�CU/n <br />CONTRACT PRICE OF WORK <br />�i�i? 1�h�,K/L /��f7f (/�E� <br />'�� , SL�f'A/'-A� G' iL�l'.i't. i �i/' .L 3',7 !•CC <br />�f � � '�=' - � <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />NC — air handling unils <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplacc <br />Gas range <br />Clothes Aryer <br />Range hood <br />Exhauslfan <br />Heal pump <br />Unil healer <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TN( CODE IS 3705 <br />i hereby cerilify that I have read and ezamined Ihis applicalion and know �he same lo be true and correcL All provisions of laws and <br />ordinaces governing this type of work will be complied wilh whelher spocitied herein or nol The granliny of a permit does not presume <br />�o give authority lo violate or cancel Ihe provision of any other slate or local law regulating conslruction or ihe per(ormance of <br />conslruclion. Thal I am authorized by lhe owner ol lhis property to perform lhe work for which applicalion is made and I comply with the <br />State Conlractors aw 1t327 RCW and 296.20U 41�AC. <br />-�-�, ���- ���� 1�� lv�� <br />��: , I <br />'/� <br />