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P�RMIT APPLICATI(�N <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 />SITE ADDRESS <br />�sa,�tUt,�m��•t. f7t+���u/4•4edo3 <br />LEGAL LOT NO. BLOCK <br />DESC. ��j> �/ Q - Q� <br />o-' � • �1.���.�r <br />TENANT <br />PARCEL TAX I.D. N <br />TRACT OR SUBDIVISION M <br />CONTACTfORPERMIT <br />ii <br />% �o <br />PERMIT # <br />� y�'. yzs 3 <br />PHONE <br />..� <br />� .�: ,��. .�. <br />CONTR. LICENSE # <br />USE OF BUILDING <br />�W�I/ER <br />HEAT�OURCE <br />Eleclric � Gas _ Other <br />WORK DESCRIPTION �t�G /Ii� ��/''Z r, <br />� %�''"�- � �rn✓I�Oa � �-, �%�� � �arrnwa�ti � <br />�-e�i�� � ��*��'���` � ��� ^"'�i <br />NO. I TYPE OF FIXiURE OR ITEM <br />Toilet <br />�athtub <br />Lavalnp• (wash basin) . <br />Shower <br />Kitchen sinA & dispos�l <br />Uishwasher <br />Clolhes washcr <br />Waler healer <br />Sink (servicc/badmop/cic.) <br />6ackllow preven�er <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Grease Irap <br />Rool drains <br />Olher __ <br />� �� <br />G/ %3 <br />PRICE OF WORK <br />,�OD � <br />�� /t' �a� <br />��.Gu.�^ �/� <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C — air handlinc� units <br />Forced air sys!ems <br />Gas piping <br />W aler hea�er <br />Gas tireplace <br />Gas range <br />Cblhes d��er <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boilcr <br />Refriyeration <br />Woodstove <br />CIN OF EVERETT �.00AL SALES TAX CODE IS J105 <br />I hereby cerilily thal I have read and examined lhis applica!ion and know lhe same lo be true and correct. All provisions of laws and <br />ordinaces yoveming Il is lype ot work will be complied wilh whclher speci(ied h�rein or nol The granting ol a permil does not pr�sume <br />lo give authurity to viol le or c cel Ihe provision of any other state or local law regulaling construclion or ihe pertormance of <br />conslruclion. TI al I an ori d by 1 owner of Ihis property to pertorm lhe work for which application is made and I comply with Ihe <br />Slate Conlracto w R and G.200 WAC. O <br />� (,! ��' 20fI�J. _ <br />Si�nalur ie d uthori Agenl Date � <br />< � �Z <br />