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P�RMIT APPLICATI(.�� <br />(;ITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERE7T, WA 98201 <br />425-257-8810 - FAX 425-257-8f157 - www.ev�rettwa.org <br />APF: ICAT��NS ARE ACCEPTED FROM 8 AM TO 4 PM - DE81T 8 CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS �t �` PARCEL TAX I.D. # P/E��RM�IT) # f <br />��,o ���, r�, , /,�_( �_�I� I 6- � —�L'1Lr/� <br />LEGA LOTNO.� BLOCK TRACT <br />DESC. <br />C_�lcl���-�} �r�j •�, � '�i <br />TCNANT NAME y` ' <br />CONTRACTOR <br />CUNTR. LICENSE N <br />USE OF BUILDING <br />�c � �-�a <br />CONTACTFOR PERMIT <br />ADDRESS <br />'- I 1'�`�-1 <br />I HEATSGURCE <br />I_ [Icctric _ Ga:: _� Olhcr <br />GTY/ZIP PHONE '�. 3�y _ Sy � <br />�6'ttc�{� lJ� `�$�c $ <br />PHONE � <br />CITY2IP PHONE <br />� CONTRACT PRICE OF WORK <br />WORK DESCRIPTIOt 1 <br />.�`nCIL Z\.�i�C��IA"��0� ! `�l: W��� �rl Il�l � ��ii�GJ�. <br />�,'� i1t i: ..I <br />i,,_-��<<► <-i< �� r�; c i��dE�� � I,� <<I<�� y ��, �_��i �,������. �i �� s��,�l <br />,', �., i.��.. �' r�,.,�_ <br />NO. I 1YPE OF FIXTURE OR ITEM <br />_ Toilcl <br />Fialh�ub <br />Lava;ory (wash basin) <br />Showcr <br />Kitchen sink & dispasal <br />Dishwashr.r <br />Clolhes washer <br />LaunAry tray <br />Sink (servicelbarAnoplcicJ <br />Backflow provonter <br />Urinal <br />Drinking F�unlain <br />Floor drain <br />Groasc trap <br />Rool drains <br />Olher <br />NO. I TYPE OF FIXTURL' OR ITEM <br />A/C - air har.11inp unils <br />Forced air systoms <br />Gas pipinc� <br />Waler hoaler <br />_ Gas lireplaco <br />Gas range <br />Clo�hos dryer <br />Ran�e hood <br />Exhausllan <br />Heal pump <br />Unit heatcr <br />Boilor <br />Refrigeration <br />Woodslove <br />Olhor <br />CITY OF EVERETT LOCAL SALES TAX CODE IS NOS <br />I hereby ceri�ity that I have read and examined lhis application and know the same to be true and corroct. All provisions ol Iaws and <br />ordinaces yoverning this type of work will be wmplied wilh whother specilied homin or not. The granUng of a permit does not presume <br />to give authonty lo violate or cancel tha provision of any other stato or local law regulaling constniction or the performance of <br />conslruclion. That I am authorized by tha owner ol this proporty to porform the work for which applicalion is made and I wmply with Ihe <br />Slale Contraclois Law 18.27 RCW and 296.200 WAC. <br />,�-_� _!_.-:.-_ - /%%f �- ll - �� <br />