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SITE ADDRESS <br />,;� <br />LEGA F LOT NO. <br />DESC. C <br />TENANT NAME <br />PERMIT 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. # <br />� /� ��G���.� �� <br />BLOC TRAC OR SUBDIVIStON # <br />C./ ����'�� / <br />,� y,' <br />� �,,�L'��"� W�'�=-t"'�� <br />CONT'R. LICENSE # <br />USE OF BUILDING <br />� ��,�� <br />WORK DESCRIPTION <br />NO. <br />PLUMBING <br />�� <br />PERMIT # <br />�C�� C>C� �-� � i i I- v�� <br />%%C%� /'����� 1 �=�v <br />CONTACT FOR PERMIT PHONE � <br />. ��� �'l�l IM' � e-Ma� <br />ADDRE � rCITY2IP F <br />� f''Sl�'v'L� � � YC', � X � ���J <br />C�-471� `f� T�v��i S <br />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 heater <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 />HEAT SOURCE <br />Electric _ Gas _ Other <br />`� `�Z7 `f� �; <br />; � ��� <br />�� �� /� <br />PRICE OF WORK <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 fi�eplace <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 />1 hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether spec'rfied 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 Contract9rs Law 18.27 RC and 296.200 WAC. <br />� <br />« � z=� l9 ��' �'� <br />Signatur o Owned ontractor/Authorized ent Date �` <br />�"�' <br />