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PE�:MIT APPLICAil01� <br />CITY OF EV�RETT PERMIT SERVICES <br />3200 CEDAR STREEI', EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTE6 FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX �.D. # RMIT # <br />llnll --r'�TH.-A�,v �.F �P�r�� I � nr��a�,� D � �'"% � --�3 <br />LOT NO. I BLOCK I TRACT <br />DAvtS SCI-tUr���2, IVIc. <br />CONTR. LICENSE # <br />�AV IGSI 1in<, �Iv <br />USE OF BUIL�ING <br />CONTACTFOR <br />'�Rd�kCv��� <br />`I�OSa- <br />PHONE <br />Ic1Y1 (A�c�\ i„�[') - c„ lnlnx I��' <br />.�o�Do -qqn� �„eW �te28o <br />L�v�nwvocl� v.�� °►ao3� <br />HE,AT SOURCE <br />'� �k1>tltJ��New Unci�er c1.e�ttr�d <br />�V1l�SICd�1 T�rnpy (�ce Cg) I _Electric _Gas�Other���"+ <br />WORK DESCRIPTION TVI�i'lf�lMP�'DviY1�QV�-- p� Uy� e x\S�I'ly� (Ze.rtnil S� <br />IZea�vc+ticv�S -b iv,cl��c�t �h�ehor p'..FYy1olif�ov�, -�,r-4��1iov,S. <br />N0. I 1YPE OPpIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backilow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />� <br />(�iZs)� �5- �wod <br />CONTRACT PRICE OF WORK <br />�p5, G o c� <br />u.SC. as o-FF�c,� <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gac fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />[xhaustfan <br />Heat pump <br />Unit heater <br />Bailer <br />Refrigeration <br />Woadstove <br />Gther <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby ceritify lhat I have read and examined lhis application and laiow the sama lo be true and correct. All provisions of laws and <br />ordinaces governing Ihis type of work will be complied with whelher specitied herein or not. The grandng of a permit does not presume <br />to give aulhonty to violate c,r cancel lhe provision of ar.y other state or local law regulatir,g con: Wction or the performance of <br />constr�ction. That I am authorized by the owner of this property lo perform lhe work for which =.pplication is made and 1 comply with the <br />State oqtraclors La� 18.2� RCW and 296.200 WAC. � 2 <br />/ / In i <br />