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P�RMIT APPLICATI(�N <br />CITY OF EVERETT PERMIT SERVICES (� I <br />3200 CEDAR STREET, EVERETT, N�A 98201 �/� ,1 �3 <br />425-257-8810 - FAK 425-257-8857 - www.everettwa.org �� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />LOTNO. <br />W C CVG}� I DI <br />BLOCK TRACT <br />PARCEL TAl( I.D. N <br />P MITN <br />�� �2 <br />� Rflt. �-it.. w• n/i. <br />CI IZIP PHONE <br />Puq�� SoHnd I-1vm�s o�Fa.er�+F 1.LL 3�25 -°I VH^ PI. SE C'�ir��� �25. e�.lb3o <br />TE .SNT NAML• I CONTACT FOR PERMIT P►IONE <br />.�L1]��UVY1��U _ CiIA►�-.1U%INfON �i25•$i0. Il.3Q_ <br />CONT ACTOR C00.5,�a.I �+v�S7 v�n-�� �Y1 ADD jy 1� L� (�f h PL S•E' CITY2IP PHONE <br />CONTR.LICENS�N ��1D� �y1j) <br />Goas7�_�F.fJ E�`''`t� �'„�' D70'/63'v <br />USE OF BUILDING � HEAT SOURCE COMTkACT PRICE OF WORK <br />���6C�fIC � CiR'i OIIIf!j - I I OyOOD. _� <br />1 <br />WORK ESCRIPTION <br />GoV�siVuc{ Vu�w S��jL� �-umily V�sicitvit,c. ,�l�/LL �4�� <br />NO. � TYPE OF FIXTURE OR ITEM <br />�_ TOilot <br />� Bath�ub <br />_>'�_ Lavalory (wash basin) <br />�-_ Shower <br />_, �_ Kitchen slnk 8 disposal <br />� Dishwasher <br />,�_ Clolhes Nasher <br />�_ Laundry tray <br />_ Sink (scrvice/barlmop/otc.) <br />Backllow prevenler <br />Urinal <br />Drinking Founlain <br />Floor Arain <br />Grease lrap <br />�_ Rooldralns <br />Olher <br />idECHANICAL <br />NO. � TYPE OF FI%TURE OR ITEM <br />I NC - air handliny uni�s <br />� ForceA ai� systems <br />.�_ Gas pipinp <br />�__ Water ha2ter <br />I Gas firoplace <br />� Gas ranc�o <br />�, Clothes dryor <br />�RangohooA <br />Ezhaust fan <br />_ Heat pump <br />Unil heatnr <br />Boiler <br />�Relrigeratlon <br />Woodslove <br />CITV OF EVERETT LOCAL SALE9 TAX CODE IS J105 <br />I horeby cedtity that 1 have read and examineA Ihis application and know lhe same lo be Irue and correct. All provfslons of I�ws end <br />ordinaces govaming this typo ol work will be complled wilh whother specifiod herein or noL The granling of a permlt does not presume <br />to giva authonty to viola(e or cancel Iho prov!sion of any other sta�e or local law rec�ulaling consiruction or tho performance of <br />conslruction. That I am authoriced by lhe ownor ollhis pmperty to porform !he work for whlch application is made and I comply wilh lhe <br />Stale Contractols Law 18.27 RCI�J ar.d 29fi.200 WAC. <br />"�—� 3CI r $ 2ooy <br />z�;d genl Date �� <br />d <br />