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SITE ADDRFSS <br />01 5 ('ae.� <br />LEGAL LOT N0. I � <br />DESC. <br />TENANT NAME <br />CONTRACTOH <br />CONTR. LICEN$E M <br />USE OF BUILDIN6 <br />� �RMIT APPLICATI� N <br />CITY OF EVERETT PERMIT SERVICES <br />32C0 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />4PPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />J�� J PARCEL TAX I.U. N <br />BLOCK TRACT <br />WORK D SCc� F�� ^, �RIPTIO J.� <br />�� . <br />.l.pciar� 20� <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Levatory (wesh besin) <br />Shower <br />Kitchen sink & disposal <br />Dishwesher <br />Clothes wasfier <br />Leundry trey <br />Sink (service�barlmop/elc ) <br />BackAow preventer <br />Urinai <br />Drinking Fountein <br />Flaor drein <br />Grease lrap <br />Roof drains <br />Other — <br />��ClE 1jo2 <br />ICONTACT FOR PERMIT PHONE <br />�I"P�'�.�/Q/�he� �25-75�/-/S�'f <br />���ooRESS cinaiP y� N�� , �'i70 <br />�f5/i 5�� r(/�/07 �Q.���/!/td' !�(iA— <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ ElecMc ✓ Gas _ Other <br />(,C� � i-I / <br />NO. I TYPE OF FU(TURE OR ITEM <br />AIC — air handting unRs <br />�Forcad eir eystems <br />Ges piping <br />L, Water healer <br />,t Gas fireplace <br />� Ges range <br />1 Clothes dryer <br />�. Range hood <br />� Exheustlen <br />Heel pump <br />Unit heater <br />~ Bolter <br />� Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL 8ALE8 TAX CO�E 19 ]106 <br />I hereby cerilify Ihal I heve read end exemined this epplicelion end know the same to be lrue end conect. All provislons of lews end <br />ordineces governing this type ol work vnll be complied wilh whether apecified herein or not. The grenling ol a permH doea nol presume <br />to give euthority to violate or cancel the provision of e�y other state or local law raguletlng canstrudion or the pertormenca of <br />construction. Thet I am euthorizeH by the owner of lhis property lo perfortn the work tor which applicalion Is meda and I comply with the <br />State Contractors Lew 18.27 RCW end 296.200 WAC. <br />' ,"!%! �, <br />i C. <br />ignature o wnerl ontrndor/ uthorizetl Agent et� 8 �I' ` <br />7 <br />