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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVIC;ES <br />�200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org ;, <br />� yc' GC ; �l- <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADD SS_ I <br />/i <br />LEGAL LOTNO. <br />DESC <br />W N�R <br />� <br />TENANTNAME <br />BLOCK <br />CO TRACTOR <br />�lr�� �n�6.m�5,`r.rc <br />CONTR. LICENSE � <br />�-�TZS1-lS. ' <br />USE OF BUILDING <br />�� 1` <br />WORK DESCRIPTION <br />3QS�c.�l3� <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />8athtub <br />Lavalory (wash bas�n) <br />Shower <br />Kitchen sink 8 Aisposal <br />Dishwasher <br />Clothes washer <br />Laundry Iray <br />Smk (service'bar!mopietc ) <br />Ba[kflow prevenler <br />Unnal <br />�rinking Founlain <br />Floor dra�n <br />Grease trap <br />Roof drains <br />Other <br />TAX 1.0. N <br />Y"� <br />PERMIT <br />ADORE55 � U <br />SC,�Me C�(%W+�Q•i <br />HEATSOURCE <br />_ Eleclnc �as _ Other <br />A <br />PNONE <br />zo�-�c7�-�U� <br />CITYIZIP PNONE <br />ICONTRACT PRICE OF WORK <br />� �� `���� �C9uh�� <br />�ULu��1 0 n1,pL'�h <br />MECHANICAL <br />NO. I TYPE OF PIXTURE OR ITEM <br />NC — air hantllmg units <br />Z Forced air systems <br />Gas piping <br />Water heater <br />Gas fueplace <br />Gas range <br />� Clothe5 dryer <br />� Range hood <br />� E.haust lan <br />Heat pump <br />Umt heater <br />Boile� <br />Refrigeretion <br />Woodstove <br />Othe� <br />CITY OF EVEREtt LOCAL SALE9 TAX CODE IS ]105 <br />I he�eby cenidy Ihat I have read and examinetl tnis application antl know lhe same to be true and correct All provis�ons of laws and <br />ordinaces goveming Ihis type ol work will be compiied with whether speafied herein or not The granlmg of a permit dces not piesume <br />to grve authonly to violate or cancel ihe proasion of any other state or local law regulahng construction or the performance ol <br />construc6on That I am authorized by the owner of Ih�s prope�y to perform lhe work lor which epplication is mad< and I comply wdh the <br />Stale CoNract�ra Law �8 27 RCW �nd 1�96 WAC <br />� �'�'�l1 l � ���l� 'fi .�� /9 /l/ <br />S�gnature of Owner:C tractonAuthonzeo Age� ate � <br />2 <br />YI <br />