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PcRMIT APPLICATI(�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEP.ETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.e�'erettwa.org <br />� -�� ,32 <br />l� <br />APPLICATIONS ARE ACCEP'f►_'D FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADORESS <br />- Ol�� I. W. '�v;Ylk� <br />LEGAL LOT NO. 1 dLOCK <br />DESC. � I i LD�J YA _ <br />"�P <br />OWNER <br />NAME <br />CONTACTfOR PERMIT <br />PHONE <br />� ADDRESS CITV2IP PNONE <br />Coasi�l Caxsi�vu.e�+ruh 3y l s 9b>� P� ��� l`iZs ) <br />CONTR. LICENSE M BLVI� <br />co�srcrzq��i t�ERe;r Wnth 8�o-ib�o <br />USE OF BUILDING � HEAT SOURCE � CONTRACT PRICE OF WaRN <br />_�1J�14.�U1L <br />WORK DESCRIP110N <br />Elect�lc � Gas _ Othar <br />Cons�-ru.�.� hcw sinyla �um�(.y v�s�d�nu.. y�GDIC. �4�l <br />PLUMBING <br />NO. I TVPE OF FI%TURE OR ITEM <br />Toilel <br />Bathtub <br />Lavalory (w�sh basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwashar <br />Clo�hes washor <br />Laundry iray <br />Sink (serviceNadmop/etc.) <br />Backllow preventor <br />Urinal <br />Drinking FouNain <br />Floor drain <br />G�ea:;e trap <br />Roof drains <br />Olher <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />AIC - air hand6ng unils <br />Forcod air r.ystnms <br />Gas pipin� <br />Watar heatcr <br />Gas fireplaco <br />Gas rnngo <br />Clolhes dryer <br />Ran�e hood <br />Exhausllan <br />Heat pump <br />Unil huatar <br />Bollar <br />Relrigeralion <br />Woodslove <br />CITV (�F EVERETT LOCAL SALES TAX CODE IS 9705 <br />I hereby co�ilify ihal I have road ano examined lhis applicalion anA know lhe same to be Irue and correr,t. All provlslonr of laws and <br />ordinaces goveminy ihis rypo ol work will be complied wilh whether specified herein or noL The granting ot a permit dous not presume <br />lo give aulhon�y to violate or canr.el Ihe provlsion ot any olher slale or local law regulaling conslruc�ion or ihe performance ol <br />construction. That I am authorizod by the owner of ihis properly to peAorm Ihe work for which applicatlon Is made and 1 comp�y wilh Ihe <br />Slate Contra ors Law 18.27 RCW �nd 296.200 WAC. <br />'�L ,1�..�. �,,,� 3 2ca <br />Signature wner onl ctor/Aulhonze Agent —�� �6te � <br />� <br />