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SITE ADDRESS <br />LOT NO. <br />DESC. <br />PtRMIT APPLICATIUI� <br />CITY OF EVERETT PERMIT SERVICES <br />3�00 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. # <br />��,., c.i w47 yr�/ % <br />BLOCK TRACT <br />� <br />-c"�%3 <br />TENANT NAME COM1TACT FOR PERMIT PHON[ <br />CONTRACTOR Q� �_����L '� � ADDfiESS ����� «II� GTYIZIP PHONE <br />7– ��; � l� Yc%['���:�1 lri <br />CONTR. LICENSE # �� �� ��� � ���� � ��� �� <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />Eleclric Gas Olher <br />WORKDESCRIPTION �'���5-�'����"'� �AL jc�G �(y� S«Q��PY 1'�'�t Sy�'1^`� T"' �1aU <br />NO. I TYPE Of FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />_ Dishwasher <br />Clothes washer <br />_ Laundry Iray <br />_ �ink (sr.rvice/badmop/elc.) <br />_ Backltow preventer <br />Urinal <br />_ Drinking Founlain <br />Floor drain <br />Greasc trap <br />Roof drains <br />Olher <br />NO. I NPE OF FIXTURE OR ITEM � <br />A/C – ai. handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />0 <br />Gasfireplace �-- �j <br />Gas range � , �� �� <br />Cblhes dryer � , � � <br />Range hood � ' <br />Exhaust fan � �' �� <br />Heal pump '� � ` �! <br />Unit healer � U' C <br />E3oiler n` <br />Refrigeration J <br />4Voodslove d <br />Other�,. c i��, <br />—�{�� ' <br />CITY OF EVERETT LOCAI SALES TAX CODE IS 3705 <br />I hereby ceritify that I have read and examined lhis application and know lhe same lo be true and correcL All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or noL The granting o( a permit does not presume <br />to give aulhonry to violale or cancel the provision o( any other state or locai taw rec�ulating construction or the performance of <br />construclion. That I am authorized by lhe owner of this property lo perform the wark for �vhich applicatiun is made aod I comply with Ihe <br />Slate Conlraclyrs Law 1f3.27 RCW and 296.200 WAC. <br />/�l 'J <br />I/2 <br />