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P�r�MIT APPLICATIG�d <br />CITY OF EVERETT PERMIT SER�JICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br />SITE ADDRESS <br />�67>2o y��'��� S� Ev<rct� <br />LEGA LOT N0. BLOCK <br />DESC. � 7 (J06 (J--00 <br />U4n J�l�m <br />TENANTNAME <br />h {r <br />F� <br />CONTR. LICENSE # �/,' /�r� <br />��j�. <br />USE OF BUILDING <br />_���jU�-l�-i� f'/-llilL% <br />,�, f R�s�d��<< <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />� qr� ��� SE <br />CONTACT FOR PERMIT <br />HEATSOURCE <br />_ Electric � Gas _ Olher <br />I�/ <br />�� �a�/`/� <br />PERMIT # <br />I�IC�::,� UI�'� <br />'HONE <br />'19.S-33o—/yo9 <br />PHONE <br />CONTRACT PRICE OF woKK <br />WORK DESCRIPTION fi h y �� f{ �-t <br />�KfrnO�in� -i"4 0 ,yci2roo�n S v ° �S x / � <br />Np, I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE �� FIXTURE OR ITEM <br />A/C — air handling unit:; <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />Other — <br />CiTY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify lhat I have read and ezamined this application and know the same to be true and correct. All provisions of laws and <br />ordinances governing this type of work will be complied wilh whether specified herein or nol. The granting of a permit does not presume <br />to give authority to violate or rancel the provision of any other stale or local law regulating wnstruclion or the periormance of <br />wnstruclion. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Coniradors Law 18.27 RCW and 296200 WAC. <br />06�� S? ,�,,,,�,P y/I�./� � <br />Signature of OwnerlContractur/Authonzed Agent Date I/� <br />