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P�.r�IViIT APPLICATIG.J <br />CITY OF EVERETT PERMIT SERVICES <br />� 3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-&857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARD3 A'<E NOT ACCEPTED <br />''� SITE ADDRESS �� � PARCEL TAX I.D. # PERMITp <br />, i�_1�_1�:� �� 5��� COs37`f-ddo Dy5'- a C Gd506 -03 � <br />i lfGAl LOTNO. <br />, UGSC. � •yt � ��a <br />�i OWNER <br />L7 <br />TENANTNAME <br />BLOCK TRAC7 <br />,� <br />r <br />CONTRACTOR <br />r�v�i�.�{�j ff�.».-� x,��� <br />CONTR. LICENSE N . <br />IISE OF <br />� --- � �- /� <br />! WORK DESCRIPTION <br />` � %�t _� . �f <br />. <br />CONTACT FOR PERMIT <br />ADDRESS CITV/ZIP <br />J 4 rK-e <br />HEATSOURCE <br />_ Geciric� Gas _-- Olhar <br />1 /I <br />5'i�/< <.:5, � i� <br />- � ' -- <br />i PLUMBING <br />i NO. I TYP[ OF FI%TURE OR ITEM <br />Toilcl <br />,'.- . HolhWb <br />�. �._ Lavalury (wash basin) <br />j Showcr <br />�, / Kilr.hen sink 8 disposal <br />' i Dishwasher <br />�. / Clolhes washer <br />I % _ Laundry Iray <br />. Sink (sarvic�/badn•op/etc.) <br />'�, 6ackllow praventer <br />I Urinal <br />� � Dnnkinr� Founl2in <br />I Floor drain <br />_ Greaso tr.ap <br />' Rouldrain, <br />Othar <br />y,:� "-15—z -� <br />PHONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />< <- <br />!� �r��� <br />NO. I TYPE OF FIl(TURE OR ITEM <br />IUC - air hvidling unils <br />f _ Forr.ed alr systems <br />.�_ Gns pipin� <br />�_ INater heater <br />(_ Gas lireplace <br />Gas ranyo <br />_ 7 Clolhes drycr <br />�_ Ranyohood <br />—%�, E■hauslfan <br />__ Hent pump <br />Unil healer <br />__ �oiler <br />Relrigeration <br />Woodslove <br />Othe�r <br />CITY OF EVERETT LOCAL SALES TA% COOE IS J105 <br />I hereby coritily Ihat 1 have read and exemmed this applic.ilion �nA kncw Ihc s�mo to 6e trur .{nA correcL All provisions ot laws and <br />��rJmares �overnin9 Ihis rype ol work will 6e comphed wilh whether spr�cilied herein or nol. 1'he c�ranliny ot n permit doos not prosume <br />tu give aulhonty lo violale or cancel Ihe provision uf any othor stale or local law re9ulaling consiruction or the porformanca ol <br />���nstrucliun That I am aidhorizeA by ihe owner ul Ihis propeAy lo pedorm iho worH for which applicalion i; made and I comply wilh Iho <br />���I,de Contrec;tors Law iB27 RCW �igf 29G200 WAG. � <br />�-<7../D <br />