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PERMIT APPLIC�`Tf0�9 <br />�ITY OF EVERETT PERMIT SERVICES <br />3200 CEUAR STREET, cVERETT. WA 98201 <br />4�5-257-8870 - FAX 425-257-8857 -wvvw.eve�ettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />9.ITE ADDRESS <br />�f3al i4� A�� �' Si-e- � <br />LEGA LOT NO. �LOCK <br />GESC.� <br />Jl �1�� <br />PARCEL TAX I.D. tl <br />2�do5l�oo3o4yoo <br />TRACT OR SUBDIVISION q <br />-�cNA�r:x �sh. <br />� 6 �� <br />PERMIT # �I <br />l-,D�b'Z - 00`� ', <br />E (c�l S�( <br />"fHNANT P AME.1 CONTACT FOR PERMIT � PHUNE C( 2S= �S —(S!c% �� <br />�i1S5 N��i1tL ��A Q i <br />LI�A NiaLl4E1.i h 1� �O� E.MAIL I�'1�2YSIg�1�O�GOI•C�'4t <br />-�a°r�A� . ` a.., 1 u� ��4 t�w 9 d L E�¢retf 9 82af 4 z.s-r.�s-�s , <br />T�ni�,vKaiia.a-1 Sig... Coutip � y Q ��; <br />CONTR. UCEMSEt! <br />tr��r�,2Scq��f Q K <br />USE OF BUILDING I HEA7 SOURCE I CONTRACT PRICE OF WORK <br />(' R�Ll.4 �i.P.✓C-1 a. � I _ Flectric Gas Other � �-10(�0� I <br />Vv'ORKDESCRIPTION �b�W"�t. ��O �i'� TISx4� �-Zy✓L QIiSS �`+��� S� <br />��0. <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />Batfitub <br />Lavatory (wash basin) <br />Shower <br />I<itclien sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar'ine�vetc.) <br />Backtlow prevenler <br />Urinal <br />Drinkiny Fountain <br />Floor drain <br />Grease trap <br />Rool drains <br />Other <br />N0. <br />TYPE OF FIXTURE OR ITEM <br />A'C - e�ir handling units <br />Forced air systems <br />Gas piping <br />W�ter heater <br />Gas fireplace <br />Gas range <br />C'��+hes dryer <br />Rangehood <br />Ezhausifan <br />Heat pump <br />Unit I-�eater <br />Boiler <br />Refrigeration <br />Nloodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� hereby ceritity ihat I have read and examined this applicatien and know the same to be true 2.nd wrrect. All provisions ol laws and <br />eidinaces governinc� Ihis rype ol work will be complied with whether soecitied herein or not The granting ol a perrnit does no� presume <br />io give authonty ro violate or cancel the provisicn of any other state or lor.al law regulating corswction or the perlormance ol <br />�:onslmcGon. That I am authorized by ihe owner of 8iis property to pedorm �he work for wl�ich application is made and I compty with ihe <br />State Conir ctors l.a�u_t827 RCW �and 2962U0 WAC. � <br />,^ �� a v� C'J 3-`7-� ► <br />:;Ignature ot Uwner;Contractor/Authonzed Agent Date /? <br />� -- -- - — — - -- ----- <br />