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9CRMIT APPLICATI6N <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 />—O% <br />SITE ADDRESS p PARCEL TAX I.D. N PERMIT # <br />2b0+ GV'a�c�" A✓ti Eve�ef}�wV1 0o <br />LEGA LOT NO. 1 //� BLOCK TRACTOR SUBDIVISION M <br />DESC. 22 li{Qti L� t771 DuO -----'— <br />obgn ! rc1 <br />TENANT NAME <br />SAL1-S?Ac.ZrJT <br />0dn ✓" <br />CONTR. LICENSE N <br />nvvnw.a <br />2gat 61 fa/t 40L ltt.t /I} `fz-4L4S 7 0 <br />CONTACT FOR PERMIT PHONE <br />E-MAIL <br />¢ -s 'H4. 4- 5-v d <br />USE OF BUILDING HEAT SOURCE I GONTRACT PRICE OF WORK <br />V 1 1; C I J: Electric _ Gas _ Other 2 0-8 6 t r" S <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <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 />A/C — 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 />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. The granting 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 the work for which application is made and I comply with the <br />State Contractors Lawll8.27 RQW and 296.200 WAC. <br />D 5 (S a-i- <br />D to 1/2- <br />