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PtRRRIT APPLICATIQN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-881U - FAX 425-257-8857 - rrww.eve�^ttwa.org <br />APPLICATIONS 4RE ACCEPI'ED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />z� �e 9� Ql, � <br />LEC;AL LOT N0. B�� <br />DESC. �C <br />� c , i <br />OWNER <br />NAME <br />y <br />PARCEL TAX I.D. p I <br />� e o� 1 � � 0 5°yS«- �,� <br />TRACT <br />_S� - Oo2 -c:�.s <br />I(-1i�.�, � �,�: � i`:,� `' N o <br />I CONTACT FOR PCRMIT <br />� ' ��� <br />�RMIT N <br />, <br />/', /-� �i <br />PMONE � Z J — <br />151`io 330- 0U�1�I <br />PHONE <br />CONTPACTOR ADDRESS CITY2IP PHONE �-tZ S� <br />JC'i��IJ,��,�4r�•,r�� •'-�. �'7 . . <br />CONTR. LICENSE M � �' � <br />�-1t�C���ia u3�lmw II"�0.). 3"i'' �� � •�t <�rvoH `i�st�iv �'�D C�14�� _ <br />USE OF BUILDING HEA1 SOURCE I GONTRACT PRICE OF WORK <br />� Eledric � Gns Olhor <br />� � �—_-_-- .. __— —.. � — I <br />WORK DESCRIPTION <br />�� �� �-F- I l� "_. <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilot <br />Balhtub <br />Lavatnry (wash 6asin) <br />Showcr <br />__L Kilchen sink & disposal <br />_L Dishwashcr <br />� Cbthr.s wather <br />i Wator heatur <br />Sink (sarvice/b�r!mopletc. � <br />BackOow prevenler <br />Un,.il <br />_ Drinking Founlain <br />Floor drain <br />_ Grease trap <br />Fool drains <br />Olher <br />N0. I TYPE OF FIXTURE OR ITEM <br />NC - av handlinq units <br />Fcrcod air sy�lems <br />Gas piping <br />Water healer <br />Gas (ireplace <br />Gasrange <br />Cbihes dryer <br />Range hood <br />Ezhaust lan <br />Heatpump <br />Unit hoaler <br />Doiler <br />Relrigeralion <br />Woodstove <br />Other <br />CITV OF EVERETT LOCAI SALES TA% CODE IS �105 <br />I hernby cerilify Ihal I have read and examinod lhis applir.a�ion and know the same to be irue and mrrect. All provlsions of laws and <br />ordinacos �overning ihis type of work will be complied wilh whe�hor specilied herein or not. The granling of a permil does nol presume <br />to give aulnorily to violate or cancel Ihe provision ol any olher stale or local law regulaling consiruction or lhe peAormance of <br />r.onslruc;ion. That I am eulhorized by �hn owner ol this property lo pedorm Iho work lor which application is made and I comply wl�h thn <br />Slate Conlractors Law . 7 R W anA 296.200 WAC. <br />t�.1�`��' _ <br />�a- y cs <br />Signeture ol Ow umrAc�rlAulhorized Agant Date <br />��Z <br />