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i <br />P �RMIT APPLICATI(�N � <br />CITY OF EVERETT PERMIT �ERVICES P��y <br />3200 CEDAR STREET, EVERETT, WA 98201 �� <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org � <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />aa� <br />LEGA LOT NO. <br />�t <br />/ 1 ✓'" <br />PARCEL TAX I.D. N <br />- g � 06 0� <br />BLOCK TRACT <br />� c � Ee Plkn <br />ADDRESS <br />; � Co,�� `�3� dtimP� <br />i /J � �%�S� CK \` IFCR PE� � � <br />_] <br />CONTRACTOR �O � ���:��D A[ <br />CONTR. LICENSE N %�n `/ � � � <br />� 1. / <br />USE OF BUILDING <br />HEAT SOURCE ,� 1/ a <br />/" rl <br />_ Electric _ Gas _ Other <br />CITY2IP PHONE <br />r� <br />PRICE OF WORK <br />WORKDESCRIP710N N�X�Q,� �v�t� ,b A+I�F{ /}niEn�kS 'io A P!'Q�t�•'S�7 /�QQrv..tf� Ctl� }�� <br />�+ +� qqr¢sS Rr���e -�,ao,� c���.r,nen+ w:u g� �«.a+c.c� n��ti +k �3ayc oF <br />•i-k, �w� �,,}��;� i� Pre vn¢.��;�,ti{�� Cqg;ne � <br />+, ., ,,, , _ _ _ � <br />PLUMBING �'V <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shawer <br />Kitchen sink 8 disposal <br />Dishwasher <br />Cbthes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />8ackflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeradon <br />_ Woodslove <br />Other <br />CITY OF EVERETf LOCAL SALES 7AX CODE IS 3105 <br />� <br />! h�reby ceritiy that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or nol. The 9ranting of a pertnit does not presume <br />to give authonty to violate or cancel the provision of any other slate or local law regulating construction or the perfarmance of <br />construction. That I am authorize e owner of lhis property to perform the work for which application is made and I comply with Ihe <br />State Contracrors La �Yand 29611(10 WAC. _ <br />. �3 • �nS— <br />�/a <br />