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P'�RMIT APPLICATI(��V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CED,AR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPI.ICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SI7f_' ADGR�SS �?r� I PARCEL TAX I.D. # I PERMIT #p` I <br />�4?4 rvc•.�-.Q.�.. /./,,.. z:,.,,,.ti,-c., e_�__ G5°5-Ccu <br />BLOCK I TRACT <br />DESC.r I <br />OWNER <br />Nor; �av _�,,� /Soo <br />TENANTNAME <br />�� <br />CONTRACTOR <br />Fsh���.��s IN� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />�k <br />WORK DESCRIPTION <br />�MoIrS% <br />ICONTACT FOR PERMIT - <br />l��ll IAVAo <br />ADDRESS <br />G2S F/stirr l�o�e <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />PHONE <br />3Go-333-IZ <br />CI1Y21P PHONE <br />98233 3�-�S'7-yo9�} <br />CONTRACT PRICE OF WORK <br />�zl,s-r�Ng o�Q�ce Qv��iws � S��S <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Diehwasher <br />Clothes washer <br />Laundry iray <br />Sink (service/bar/mop/etc.) <br />BackOow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. � TYpE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas pipinc� <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this applicalion and know the same to be true and correct. All provisions o( laws and <br />ordinaces goveming this type of work will be complied wilh whether specified herein or not. The granting of a permil does not presume <br />to give authority to violate or cancel the provision o( any other stale or local law regulating construction or the peAormance of <br />conslruclion. That I am authorized by lhe owner of tiiis property to perform lhe work for which applicalion is made and I comply wilh lhe <br />State Conlre�c/t�9 rs Law 1 7 RCW and 296.200 WAC. <br />_�e�Z�L�3�l��'� / (O�� <br />