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1 <br />PERMIT APPLICATtON <br />CITY �7F 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 CARD3 ARE NOT ACCEPTED <br />SITE ADDRESS p Oq S t'L JW PARCEL TAX I.D. # PERMIT � <br />EdE,QEn- ,�a9 9Pzvo,� I �U��Ec�c�o�sdz. I ;1 �n� - �' <br />LEGAL LOTNO. <br />DESC. <br />OWNER <br />3o�e <br />TENANTNAME <br />CONTfj[�CTOR <br />(o �NF <br />CONTR. LICENSE A <br />USE OF BUILDING <br />BLOCK � TRIICT <br />F���.,�d� <br />Ciirn� ��, <br />�c-si dc-urr�A.� <br />WORK DESCRIPTION <br />�,� C� <v� v <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathlub <br />Lavetory (wash basin) <br />Shower <br />Kilchen sink 8 dispwal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/moplc+tc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor ;rain <br />Grea,e trap <br />FiWf drains <br />Other <br />S5 P�- S'1.:1 <br />� CONiACT FO�a PERMI7 <br />CITYiLP PHONE <br />a���ecrr cfo?5���-/2qz <br />PHONE <br />AOORESS �iTYZP PFiONE <br />�0�01� 4�-� Src.d��,�-, wq. qE�s�- 36o.es�J <br />HEAT SOURCE � CONTRACT PRICE OF WORK <br />� Eledric _ Gas _ Other <br />�-��i -�,� <br />r <br />MO. � TYPE OF FI%TURE OR ITEM <br />AIC — air handling units <br />Faced air systems <br />Gas piping <br />Water heater <br />Gas firep�ace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhtustfan <br />Heat pump <br />Unit heater <br />Bdlet <br />Refigeiation <br />Woadstove <br />Other <br />CITY OF EVERE7T LOCAL SALES 7A7( CODE IS 3105 <br />I herehy ceritify that I have read and examined this appliqtion and know the same to be true and corred. All provisions of laws and <br />orclinaces goveming Ihis lype of work will be complied with whether specified herein cx nol. The granting o( a permit does not presume <br />to give authorty ro vidale or cancel the provision of any otl�er slate or local law reaulating construation or the performance of <br />conslrudion. Thal I am authorized by the owner of this property to peAortn the work fw which application is made and I mmply with the <br />Stale Contradors Law 18.27 RCW and'196200 WAC. <br />Signature of wner/ConVactor/Aulhonzed Agent Date <br />