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� <br />F�tRMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-H857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />SITE ADDRESS „ ,) , PARCEL TAX I.D. N <br />I�� ( tin 'jZ f � .'� v Q`�, ;���e�c C'C��?��D j�L'O <br />LEGAI. LOT NO. j BLOCK TRACT OR SUBDIVISION N <br />DESC. �+ � ' <br />/1•ia.•••• ��P�� <br />�. Er.- / ��'� <br />TENANTNAME <br />� <br />CONTR. LICEN9E N <br />C� a�,,-�--•__; <br />USE OF BUILDING <br />---- ' , � � ' <br />WORK DESCRIPTION <br />NO, <br />,��;3� sc 11� �� �r <br />CONiACT FOR PERMIT <br />f`� `-Y v �l �r" <' <br />HEAT SOURCE <br />Eleclric Gas Other <br />�.`( �,. ( r.r rfr i, r/,-.-. I . <br />� �lr ��, <br />PLUMBING <br />7YPE OF FIXTURE OR ITFM <br />1' lotltel <br />Balh!ub <br />��_ , Laia�nry (w,ish basin) <br />I Showr.r <br />. �_ Kilchen sink 8 disposal <br />� Oishwasher <br />_ ' Clulhes washer <br />� Water hoatur <br />. Sink (snrvice�bar/mop/etc.) <br />_ _ Backllow proveninr <br />Uiinal <br />. � Onnkin� Pounlain <br />Fluor drain <br />Grease Irap <br />Ruof dralns <br />Olher <br />�U6C�, c�l�l <br />'qz?o;S" 20�, ZZ2t-IS <br />PHONE 1v�. �.z z' /s//v <br />F.MAII_ ��n e i� KK l��'i l.�cLrr <br />CONTRACT PRICE OF WORK <br />NO. I TVPE OF FIXTURE OR ITEM <br />. A/C - eir hancfling units <br />i Forcod air syst�ms <br />_z Gaspiping <br />__ i Walor heat�r <br />Gas liroplaco <br />' Gas range <br />_ i __ Clulhos dryer <br />Ranqo hood <br />�_ Exhausifan <br />___ Heal pump <br />Unil heater <br />Doller <br />_ � Refrigeration <br />Woodslove <br />CITY OF EVERETT LOCAI 8ALE9 TAX CODE IS 3/05 <br />1 horeby r.eri�ily Uia� I have read end exarnined �his applicatinn am' know Ihe samo �o be true and corract. All provlsions of laws and <br />ordin�cr.s gnvwnin� Ihis lypu ol work will br. comphod wilh whclhfrc specified herein or noL Thn gr�nling ol a permil does nol presume <br />to pive authunty lo viulale or canc�l Ihf� piovision of any other slale or local law regulatine� construclion or the peAormance o( <br />conslruchon i hal I am aulhorized by �h^ uwner ul this proporty lo perform Ihe work for which epplication is made and I wmply with Ihe <br />Slaln Conlra�:Wrs Law IU27 RCW and'IJti200 WAC <br />--- �-,� ; - s -., $ , <br />Si�nelure of OwnedCuntraclor/Aull�yenl � Dale , -'. <br />� <br />