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i <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 9E201 <br />425-257-E810 - FAX 425-257-G357 — www.evere:twa.org <br />�,�,O�c��i o 37 <br />{�'C�� (�6�/' (, � <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TU 4 PM - DEBIT 's CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS , � � `I , <br />S��1L <br />LEGAL LOT NO. i BIOCK <br />DESC <br />WN�LSq�dd�11_]YIJ.e��. �o�ai <br />TENANT NAME <br />CO TRACjOR \,�,-- <br />r'i�l `.�lJ� �1�'`�5,��4�C_ <br />CONTR. UCEHSE t <br />�R-�Tz.SNs � <br />USE OF BUILDING <br />S� � <br />WORK DESCRIPTION <br />�QS��. '�`I J� <br />PLUMBING <br />N0. I TYPE OF FIXTURE OR ITEM <br />� <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 d�sposal <br />Dishwasher <br />Clothes washer <br />Leundry hay <br />Smk (servicebarhnopietc � <br />Backllow prevenler <br />Unnal <br />Dnnking Fourtain <br />Floor drain <br />Grease trep <br />Roal drains <br />Olher <br />I.D. N <br />TRACT <br />PERMIT N <br />13oC�0 �( - <br />'-''CONiACT FOR PERMIT PHONE <br />� <br />ADDRES���,�� CITYIZzn�-�(�� -l�Cy1- <br />5ume wf7wv,e-+r <br />HEATSOURCE <br />_ Eledric �as _ Othei <br />-�� <br />CONTRACT PRICE OF WORK <br />��' ''� <br />. ', ' <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C - eir handling unl�s <br />� Forced eir systems <br />�Gas piping <br />Waler heater <br />� Gas fireplace <br />Gas range <br />I Clothes dryer <br />T Range hood <br />= F�haust fan <br />Heat pump <br />Und heater <br />Ba�;er <br />Rehigeretion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE 19 ]106 <br />I hereby cerit�fy tha� I have read and exammed this apphcation and know the same to be trur and corre�ct All provisions ot laws and <br />ordinaces governing Ihis type ol wcrk wtll be complietl wdh whether specified herein or no� ne gran;;:ig of a Dermit does not presume <br />to grve authonry to v�olate or cancel the provis�on ol any other state ar local law regulating conshuchon or the perlormance of <br />construction That I am authurixed by the owner of this p�ope ty to perlorm the work for which apphcation is made and I comply with the <br />State Contraqlors Law 18 27 RCW anA 296 20p WAC /' � <br />� � � _ \ <br />i <br />�i �, "_ �rC< <�. � J r ,� l <br />S�gnature ol Ownen ntractonAuthorizetl Agent —+f6ate Z"/ <br />