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P�RMIT APPLICATIUN <br />CITY OF EVERETT PERMIT �ERVICES <br />3200 CEDAR STREFT, EVERETT,VJA98201 <br />425-257-8810 - FAX 425-257-8857 - www.everetiwa.org <br />APPLICATIONS .1RE ACCEPTED Fl20M 8 AM TO 4 PM <br />..� fE ADDRESS <br />� � <br />' � � ! ' '�� �jL(J� [� <br />LEGAL LOTNO. BLOCN <br />DF.SC. <br />OWNER <br />k�U� � L`tCLC�� ll/ S _ <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE p <br />USE OF BUILDING <br />WORK DESCRIPTION � �( <br />I.�i ILL�r-t � <br />�_ �lZ-1G <br />PARCEL TAX I D. N P MIT 8 <br />' -- � . <br />TNACT <br />ADDRESS CITV2IP PMONE �� - �� � <br />�- ��— �� ����� � i � % / e 1�T �� 7 � <br />ICONTACT FOR PERMIT —P�10NE <br />ADDRESS CITV2IP <br />� — HEAT SOURCE <br />Elaciric __ Gas _ Other <br />u -, �'r � ., , � � i� rn %y �� <br />µ0. I TYPE OF FIXTURE OR ITEM <br />7uilot ; <br />Balhrvb � <br />Lavatory (wash b�sin) <br />Shawer <br />Kllchrn sink�8 dispcsal <br />L'ishwashar <br />Go'hos wAehor <br />Wnter he�ter <br />Sink (salvicc/borlmop�etr. J <br />Backflow prev�nlnr <br />Urinal <br />Drinkiny Founlr��n <br />Floar :1r,�in <br />Grna�se� trap <br />Roo( drains <br />Othor <br />CITV OF EVERETT LOCAI SI <br />PHONE <br />CONTRACT PRICE OF WORK <br />r %��J�c�n� <br />NO. TYPE OP fIXTURE OR ITEM <br />' __ A/C - air handling uNls <br />I Forced nir systems <br />Gas piping <br />W ator hAalor <br />Ges li�eplace <br />Gas range <br />Clolhos dryor <br />,i' Ranqo hood <br />„ Fxhausllza <br />--- He..l pump <br />Unit heater <br />�uilor <br />Relrigeration <br />� ___I Woodstove <br />I _ Olher <br />I <br />LE9 TAX CODE IS 3703 <br />I hr.rrby cerilily Viat I havc: n�ad anA examined Ihis �pplicalion and hnow the same to be In!e and cunacl. All provlsions ol laws end <br />orAinaces governinq ihis typ� of warh will be complied with whe�her apecilied herein or nr�. T�c granling of e permll does not presume <br />to yive aulhorily lo violale or �xncel ihe pro�iision ol any olher slale or local law regulaling constructinn or Ihe aerformence of <br />conslnmlion, ihal I am ni�unze�d by the owner ol thrs property to pertorm Ihe worR lor which application Is mede and I comply witl the <br />SIe� si,unt�actnr�taw 1A'27 RCW anA 29G-.�AC. <br />Z� <br />- ''l, , _ l� , .i ,�.-�� / � � � / ] � /)in -/%% <br />`• SignatGlh ot UwnenGonpactouHumonz� <br />\ <br />._ , <br />