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SITE <br />PERMIT APPLICA710N <br />CITY �F EVERETT PERMIT SERVICES <br />3200 CEDAR £TREET, EVERETT, WA 98201 <br />425-257-8810 — FAY, 425-257-8857 — www.everetCva.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM 70 4 Pbt - GEBIT 3 CREDIT CARUS ARE NOT ACCEPTEp <br />�7 �1`l`�'1 � SI� <br />LOTNp� BLOCK <br />���5an `�DM�s `C�� <br />TENANiNAM� <br />PARCEL iA% I.D. N <br />uC�� '�C� �t�� d W. <br />TRACT�-_ <br />— -� c�Gl�� � 1 � -{� <br />��I: <br />CO iR CTOR AD�FE95 �T <br />��, sc�� NOM�.�C,C. �aMe GS u�J�e� <br />CONTR.LICEN9E� ��YY5Nra5y,�L,3 <br />USE �F BUILDING HEAT SOURCE <br />��� R _ Electnc . v Gas _ <br />WORKDESCRIPTION 4\� . �y�M y,T;L�" �� CInUV�(� <br />� <br />� <br />NO. I TYPE OF fIXTURE OR ITEM <br />_L <br />7oilet <br />Bathtub <br />Levatory (wash basin) <br />Shower <br />Kilchan sink 8 disposal <br />Dishwasher <br />Cbthes wesher <br />Leundry tray <br />Sink (servicePoadmop/etc ) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor diain <br />Grease trep <br />Rool drains <br />Ot�er __ <br />, cinaiv <br />Other � <br />i <br />e P �' � •11 <br />PERMIT N <br />. ��'�� _ —c�� : <br />�-�- ----1 <br />PMONE <br />1gZf� ��15�f; �3��3r� <br />PHONE <br />�'l `�t t l � <br />PHONE <br />�a�-�3�-�a�4 <br />CONTRACi PRICE OF WORK <br />� <br />�. ���_ ;, �� <br />NO. I TYPE OP FIXTURE OR ITEM <br />I_ A/G -air handhng units <br />� � Forced eir systems <br />Gas pipmg <br />�Nalerheater <br />��as fueplace <br />Gas range <br />i Clotles drye� <br />Rer.gehood <br />� Ex���aust fan <br />rloat pump <br />Un,t heater <br />Bailer <br />Refnq?relion <br />Woodstova <br />Other_. _ <br />CITI' OF EVERETT LOCAL 9ALFS TA% CUOE 19 N06 <br />I horeby cenldy tha� I have read and eMammed this epplicahon end know Ihe same lo be true and correcl All provisions ol lawy and <br />ordinaces governin� Ihis type of work will be complied with whelher speafed herein or noL The gran6ng ot a permit does not presume <br />fo gWe aulhority to v�olate or cancel the provlswn of any cG•er sta;e or local',w rr.gulaling constmclion or the peAormance of <br />construcP�n Thal I am aulhonzed by the owner ol ihis property �o perform �he �.vork for which appGcation is made end I comply wilh the <br />Slale G.itractors Law iB27 RCW and 296 200 WAC. <br />Signatureo wned oniraclm/Authonzed gert — e�� e 1/� <br />