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SITE ADDRESS <br />LOT NO. <br />DESC <br />PffRMIT APPLICATION <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 TO 4 PM <br />PARCEL TAX I.D. N <br />BLOCK I TRACT OR SUBDIVISION N <br />TENANT NAME <br />CUvi5111/tMl)yl <br />�i)T+TFFA�Tb1-FPS t e- <br />CONTR. LICENSE 0 Al <br />USE OF BUILDING <br />CONTACT FOR P IT PHONE <br />err rrcrr <br />ova II Lira,,l� Fidu <br />HEATSOURCE <br />Electric _. Gas _ Other <br />V RK DESCRIPTION 101'4V Il+t'>w'"'^"�^( � ----..J` <br />U%ki� u t� (L,#41L UIL 01,14- /�yr 1. Z <br />_ �il. r.F � /4 l <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 />_ Clothes washer <br />_ Water healer <br />_ Sink (servicelbar/mopletc ) <br />_ Backffow preventer <br />_ Urinal <br />Drinking Fountain <br />Floor drain <br />_ Grease trap <br />_ Roof drains <br />Other <br />C1l <br />4£f 1 I I 4`Z,}1 <br />1sT F&I C�� <br />(-/ - / 3 -/Z <br />PERMIT N <br />3se -o IZ <br />CONTRACT PRICE OF WORK <br />!ye0(C <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ AIC - an handling units <br />_ Forced au systems <br />_ Gas piping <br />_ Water heater <br />_ Gas fireplace <br />_ Gas range <br />_ Clothes dryer <br />_ Range hood <br />_ Exhaust fan <br />_ Heat pump <br />_ Unit heater <br />_ Boiler <br />_ Refrigeration <br />_ Woodstove <br />Other. <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know the same to be true and correct All provisions of laws and <br />ordinances governing this type of vrork will be complied with whether specified herein or not The granting of a permit does not presume <br />to give aulhooly 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 the work for which application is made and I comply with the <br />State Contr ors Law 18 27 RLCW and 296 200 WAC. <br />it �yhiGt i�5 eIZ 1 <br />� �.� niUwnedCon meter Authorized Agent Dal i 2 <br />