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SITE ADDRESS <br />LOT NO. <br />DESC. <br />PERIVIIlT AP�LICAiIOiV <br />�iTY OF EVERETT PERMI'i' SERViCES <br />3200 CEDAR STREET, EVCRETT, WA 98201 <br />425-�57-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />I . Un . i �, . <br />BLOCK TRACT <br />Y-1 \ <br />— ADD ss cinmr <br />Nti� �rC. i�l S. L1�.S� nS �ki.s+ <br />� , ;; 2 �:�'� �� �� <br />ICONTACT FOR PERMIT <br />CONTRACTOR �,�� �j ���v� ADDRE55 <br />CONTR. LICENSE # <br />L�('� pr� 1-I r;� <br />USE OF BUILDING <br />�c7 <br />� <br />WORK DESCRIPTION <br />;� isy <br />��.s;c� �,� � <br />PLUMBING <br />N0. I TYPE OF FI%TURE OR ITEM <br />Toile: <br />Bathtub <br />Lavatory (wash basin) <br />Shawer <br />Kitchen sink 8 disposal <br />Dishwasher � <br />Clothes washer ' � � <br />Laundry tray <br />Sink (servicelbar/rtiop/etc.) <br />6ackCow preventer ' <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />HEATSOURCE <br />Electric ;r Gas Other <br />N0. <br />CITYIZIP <br />PERMIT # <br />L��Q' ,Li <br />PHONE L '�!. J?3 �f , <br />ve ��5 <br />c' US�� <br />PHONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />MtGF1ANIGAL <br />TYPE OF FIXTURE OR ITEM <br />A/C – air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Cblhes dryer <br />Range hood , <br />Exhaustfan c - - � <br />Heat pump ' <br />Unit heater <br />Boiler <br />Refrigera[ion <br />Woodstove <br />Other <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />o�c <br />I hereby ceritify that I have read and examined this application and know the same to be tru�� and wrrecL All provisions of laws and <br />ordinaces goveming thi, type of work will be complied with whether specified herein or not Tha granting of a pertnit does not presume <br />to give authority to violate or cancel the provision of any other state or tocal law regulating construction or the perfomiance of <br />construcBon. That 1 am authorized by the owner of this property to perform the work tor which application i; matle and I comply with the <br />State Contractors L�w 78.27 RCW and 296.200 WAC. <br />C� � � i I�'/���!�'(L-) � I�` � I[%� <br />Signature cf wnedContracror/Authonzed Agent Da e <br />✓ <br />