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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 - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />l�h; � � �e <br />LEGA LOTNO� BLOCK <br />DESC. <br />OWNER <br />A���i sa�� �tiaMes ,iv�c, t iai <br />TENANiNAME <br />CONTRACTOR <br />Wf�� San�iprnes =hc. <br />CONTR. UCENSE i <br />Yi R.l z, <br />USE OF BUILDING <br />WORK DESCRIPTION <br />PARCEL TA% I.D. N <br />TRACT r <br />� P -� f �u - <br />ADDRESS � " <br />io�a.� f_vu9reenWy�:aS•H73 <br />N0. I TYPE OF FIXTURE OR ITEIA <br />Toilet <br />� Bathtub <br />-',,,` Lavatory (wash basin) <br />/ Shower <br />Kitchen sink 8 disposal <br />i Dishwasher <br />I Clothes washer <br />Laundry tray <br />_ Sink (serviceibar/mop/etc.) <br />Badcflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ ElecVic �[Gas _ Other <br />�'is��r�, �1�� <br />PHONE <br />PHONE <br />CIN21P PHONE <br />Evuett 4�,'�p( �{ a,S-y 3i5-b 3 L�j <br />CONTRACT PRICE OF WORK <br />�ro�je..�� nar�e. � <br />�Gcld� L.�,ne� <br />NO. I TYPE OF FI%TURE OR ITEM <br />�vG — air han0ling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Ezhaustfan <br />Heat pump <br />Unit heater <br />Boiier <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS J105 <br />I hereby centiy that I have read and examined this application and know the same to be true and correct All provisions of laws and <br />�rdinaces goveming this type of work will be complied with whether specified herein or not. The granting of a pertnit dces not presume <br />:o give authonty to violate or cancel the prodsion of any other state or lowl law regulating construction or the performance of <br />;onstruction. That I am authorized by the oK•ner of ihis property ro peAorm the work for which application is maie and I comply wiih the <br />itale ContfaIXOrs Law 1827 RCW ann 9oa �nn m�er <br />o C� �25 <br />��Z <br />