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PL�lMIT APPLICATI��i <br />CITY OF EVERETT PERMIT SERVICES <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 TC? 4 PM - DEBR 8� CREDR CARDS ARE NOT ACCEPTED <br />SITE ADDRESS <br />37v3 � <br />LEGA LOT NO. <br />BLOCK I TRACT <br />PARCEL TAX I.D, if <br />_� <br />�rvNER a,�R��� ..,, „"� �,..,,._ a�• S45 5' <br />rnbcr G� rk !`//y L4�rcn �oad PvD�� 5'yfs'�.ojyt qdu�7 <br />li� �y ��E,or/�iaF,o�i 34v �t/��.,o� , u/t <br />TENANTNAME CONTACTFORPERMIT PHONE <br />CONTRACTOR /+��� I.�iP�oliF�o/� � �G nooa�4sY�rt ��yrol�t•g���P <br />S4if� /� p <br />CONTR.LICENSEN � M�,� �p 1975 � I �' jG l q��;us <br />USE OF BUILDING <br />h�p Pl�n-f <br />HEATSOURCE <br />_ Electric _ Gas _ Other �O�Q <br />WORK �ESCRIPTION F c h� !�fiA `f (-wt/�UI �tJ.' , <br />a�.�� ��+���ti �, F 3, 9yq s� I�t v p <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Ciothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />PHONE <br />360- 39.i� ,�4o I <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC - air handling units <br />Forced air systems <br />Gas piping <br />Water heatar <br />Gas fireplaca <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />Other <br />CIiY OF EVERETT LOCAL SALES 7AX COOE IS 3105 <br />I hereby ceritiry that I have read and examined this application and know the same to be true and correct. All provisie�a at ;aws and <br />ordinaces governing this type of work will be complied wilh whether specified herein or not The grantlng of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform tha work for which application is made and I comply with the <br />State Cont�Ctors Law 18.27 RCW and 296.200 WAC. <br />�` / 4Cr�c <br />