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� <br />PERMIT <br />APPLICATION <br />CITY OF EVFRETT FERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - w�vw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEDIT 8 CREUIT CARQS ARE NOT A:CEPTED <br />SITE ADDRESS <br />I�I l�G'" S�• S. � <br />LEGA LOTNO. BLOCX <br />DESC. <br />OWNER <br />�vla��y ��C��aY <br />■r�:r_�:�� <br />CGNTRACTUR �L� �� CO�JS1 r�T <br />CONTR. LICEN9E M <br />USE OF BUILDING <br />WORK DESCRIF'TION �Ze � I a ce <br />�,� IGC P <br />NO. + TYPE OF FIl(TURE OR ITEM <br />PARCEL TAX I.D. N <br />TRACT <br />CONTACT FOR FERMIT <br />i L hr,S <br />� ADDRE9S <br />"Z2l(� <br />PERMIT N <br />— CI�YITL�1" H N <br />L�I CITY2IP <br />f����u�.J �,:� <br />HEAT90URCE <br />_ Electric _ Gas _ Other <br />1� o � <br />(` V'w-U � P r <br />TOilel <br />Balhlub <br />Lavetory (w� n basin) <br />Shawer <br />Kitchan sink 8 disposal <br />Diehwasher <br />Clolhes washer <br />Laundry tray <br />Sink (seriice/bedmop/elc.) <br />P �ckflow preventer <br />Urinal <br />Drinking Fcuntain <br />Floor drain <br />.Grease trap <br />Ruof d ins .� <br />� ocna� � w1 S�ce -^a�dP� <br />PHONE <br />yz's - ��-p65 a <br />FNONE <br />y�S -3�� -C�3� <br />CONTRACT PRICE OF WORK <br />���.�G <br />- r4n5�Iu f e <br />TVPE O� r�.:-URE OR ITEM <br />A/C - air handling uni�s <br />Forced air systems <br />Ges pipinp <br />Water heater <br />Gas fireplace <br />Gas renge <br />Clothes dryer <br />Range hood <br />Exheust fan <br />Heat pump <br />Unil hea�ar <br />Baller <br />ReMgeratlon <br />Woodstove <br />omer <br />CITY Of EVERETT LOCAL 9ALES TA7( CODE IS 710" <br />I hereby ce�itify that I have read and examineA this application end know the same to be �iue and correct. All provislons af lews and <br />ardinaces governing ihis typr, of work will be complied wdh whether specified herein or not The qranting ot a permit does not presume <br />to give authonty to violate or canc3l Ihe provision of any olher slale or local Inw regulating consiructlon or the perf �rmance of <br />constructioa That I am aulhonzed by Ihe owner of Ihis property to perform the work for which application is made and � comply with the <br />Sla� ntr�rc Law 162a�C`W�anJQ �96.?00 WAC. %'/� Ib� <br />\ v� <br />