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I� APPLICATI.UN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEP.ETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />���� i APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS �'��1� t�) A�V E PARCEL TAX I.D. # ( <br />��e�e;� wP 95203 ��+33600005r�o�'�, <br />LEG4L LOi <br />DESC. � <br />OWNER <br />:L�o� <br />TENANTNAME <br />BLOCK <br />!� 33 -c� <br />QP ��o�� c� <br />ONTRACTOR <br />���� <br />CONTR. LICENSE # <br />USE OF BUIL��4G <br />���'w c�.ti,C1c\ <br />WORK DES <br />1'� <br />r�o. <br />vw��e�- <br />\���� <br />SI f�y�.1.� {'oI h� i �� <br />(J <br />PLUMBING <br />NPE OF FIXTURE OR ITEM <br />� roilet '''/ <br />'-.R' BathWb 4 <br />" " Lavalory (wash basin) !*/! ! <br />s� Shower �/ <br />�Kitchen sink & dispos;�l <br />Dishwasher <br />�Clolhes washcr <br />Wat�r healer <br />� Sink fserviceNar/mop/etc.) /� <br />BackOow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Greasetrap <br />� Roof drains <br />� Olher <br />TRACT OR SUBDIVISION il _ <br />���t z � SP�r 33' "� <br />ADURESS S.� CITY2IP PHON[ <br />sg�s � Au�_ sE �vr- �E�'� 9&�� �4�s�3��,ys� <br />� NTACT OR PERM47' <br />����� � fS6o ,Tf.k <br />�Y��_ RES bc�s��'.i� Pe�r <br />SBIS�J � `' fLuF S� <br />HEAT :�OURCE <br />_ P�ectric "� Gas _ Othcr <br />PHONE <br />� I�-n,Ar <br />3>� -9yss• <br />)33z- 9�vs <br />I�ueac�� Wk (42S�3S� 4455 <br />9&zo� <br />M—Si ��' �—�° <br />i;4S��'X�3 h <br />CONTRACT PRICE OP WORK <br />��3 <br />3l � -r I . ;�'3�. <br />NO. I TYPE OF FI%TURE OR ITEM <br />%'�_ <br />A/C - air handlinc� units <br />Forced air sys�ems <br />Gas piping <br />Water h�aler <br />Gas lireplace / <br />Gas renge <br />Clolhas dryer <br />Range hood <br />Exhaust fan i7.�� � <br />Hcat pump <br />Unit healer <br />Boiler <br />Retrigeration <br />Woodslove <br />CIN OF E�'ERETT LOCAL SALES TAX CODE IS 91U5 <br />I hereby ceritily Ihat I have read and examined ihis application and know lhe same to be true 3nd corred All provisions ot laws and <br />ordinaces c�overning lhis lype of work will be complied wilh whether speci(ied herein or not. The granting of a permit does nol presume <br />lo give aulhority lo violate or cancel the provi: ��n ot 2ny other stale or local law regulating conslruclion or Ihe per(ormance of <br />constructio�. That � am aulhorized by the o�vn„r of ihis property to per(orm the work (or which application is made and I comply with the <br />Slale Co�yractors Law 18.27�RCW id 296200 WAC. <br />.�"�v� i�� �----. t,� 1 g�U 7 <br />Signawrc ot Owner;Conlraclor/Authorized Ayent Da!e <br />� - <br />