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F �RMIT APPLICATIvIV <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STi2EET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLIGAT:ONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.�. # /P� RM19IT # <br />`ISo���"iH����,ue, SE Suik_ Ilq �8�51�-oo3-r�s3-o� /�: -�v <br />LEGAL I.OT NO. T BLOCK TRACT <br />C��E2 I ��ET <br />� <br />Jonafilnuv� � Ino�aiL�v-i' ;. ,� ��� at,�� ST NF � aa <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />r��,�,mhiV) L- YvirAC'j_ �i�nriie 1�nin�i%iinnvunoll fl�c:.��„ �47�� 1..1n.. inlni_ ..In� <br />CONTRACTOR <br />C.onstat..�,U1- �ui�dcvs �hc <br />CONTR. LICENSE # <br />USE OF BUILDING <br />���SS 1�1�E �$Isc <br />C�71 <br />HEP.T SOURCE <br />K.ehV11oY¢, i W A <br />_ Electric � Gas _ Olhe� I � <br />WORK DESCRIPTION , <br />�hc,v�- ��IP��cvu.Z� - iJc� t Y1 y-evio� W alls i dlx�rs, s Oabiv�try <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (sen�icelbadmop/etc.) <br />BacMlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />PRICE n� WORK <br />NO. � TYPE OF FIXTURE OR ITEM <br />iVC — air f:andling units <br />Forced a'r systems <br />Gas Fiping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heatpump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other _ <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be 2rue and correct. All provisions o( laws and <br />ordinaces governing this type of work w�;l be complied with whether specified �ierein or not. The granting o( a permit does not presume <br />to give authorily to violate or cancel lhe provision of any other state or local law regulating construction or lhe performance of <br />construction. That I am�u�horized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractoil; Law 8 7�RCW and 296.200 WAC. <br />`' <br />