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t �RMIT APPLICATIC N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERE7T, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM tl AM TO 4 PM <br />SITE ADDRE3 0���l m�� �� PARCEL TAX LD. N <br />LEG LOTNO. I� BLOCK TRACT <br />�ESC. <br />TENANTNAME <br />CONTRACTOR E. /1m�Q <br />.�JY (' <br />CONTR. LICEN�E N <br />USE OF BUILDING <br />WORK U SC� RIPTION � �� <br />cL.�[JC,C:� <br />N0. � TYPE OF FIXTURE OR ITEM <br />,� Toilet <br />Bethtub <br />Levatory (wash basin) <br />/ Shower <br />_� Kitchen sink 8 dispasal <br />,�, Dishwasher <br />__(_ clotnes wasfier <br />._ Leundry trqy <br />Sink (servicePoarlmoplelc ) <br />BeckAow preventer <br />'J Urinel <br />~ Onnking Founlein <br />Floor drein <br />Grease trep <br />Roof dreins <br />Other <br />��(.�E 1/G2 <br />CONTACTFORPERMIT <br />8/C� 6� <br />ADDRESS � CITY2IP '/ P�HO, NF�� <br />95/i! `f��../�/OZ� ��o�LIW' <br />��T' <br />— HEAT SOURCE I CONTRACT PRICE OF WORK <br />Electric ✓ Ges __ Other <br />!�f �1.� J <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC - eir handling unRs <br />L Forced eir systems <br />Ges piping <br />L Water heater <br />1 Gas hreplace <br />/ Gns range <br />J_ Clolhes dryer <br />_.L Rangehood <br />� Exheust fan <br />__ Heetpump <br />Unit heater <br />—� Boiler <br />Relrigeretion <br />Woodstove <br />Other <br />CITY OF EVERETi LOCAL 8ALE8 TAX CODE 19 �1U6 <br />I hereby cerilify lhet I have read end exemined this application and know the same to be true and correcl. All provislona ol lews end <br />ordinaces goveming this type ol wark will be complied with whelher specified herein or not. The grantlng ol e permll does not presume <br />to give authonty to violate oi cancel the provision ol eny other stete or locel law regulatlng construdion or the perlormence of <br />construction Thet I em authorized by the owner ol this proparty to peAorm the vrork tar which epplication Is mede end 1 comply with the <br />State Contradors Lew 78.27 RCW and 286.200 WAC. <br />; '- �;(�j._ <br />II� <br />