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SITE DDRESS <br />��7 � <br />LEGAL LOT NO� <br />OESC <br />TENANTNAME <br />� <br />HERMIT APPLICATII,N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CED1�R STREET, EVtRETT, WA 98201 <br />425-257-8+310 •- FAX 425-257-8857 — www.evereriwa.org <br />., _. <br />APPLiCAT10N5 ARE ACCEPTED FROM 8 AM TC14 PM �1 / 1�� C <br />L (.G�I1F� <br />BLOCN TRACT <br />PARCEL TAX I D. fl <br />���(/E %oz <br />CONTACTFORPERMIT <br />� �r�t' �el�c <br />PHONE <br />/ieJ y-1S-7Sy - �S�Y <br />CONTRACTOR L . /)m��j � j �D�RESS v CITY2IP �' � N�� � , /7O <br />CONTR.LICEHSEMQ1L� •`9�/�5��ic/F'�'/oz, (G�'�'�fti�r ui�4- <br />(�CrLA'1afFL9�/�1�0 — <br />USE OF BUILDING I —_ HEAT SOURCF I CONTRACT PRICE OF WORK <br />Electric ✓ Gas _ Olher <br />WORK DESC_ RIPTION � <br />� �'�CJC_f.� � � <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bethtu6 <br />Levatory (wash basin) <br />Shower <br />Kdchen sink 8 disposal <br />Dishwasher <br />Clothes wasfier <br />Laundry tray <br />Sink (semce/barlmopletc � <br />Backllow preventer <br />Urinal <br />Onnking Fountain <br />Floor drain <br />Grease Irap <br />Roof drains <br />O�her <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - eir handlmg unils <br />Forced atr syslems <br />Gas piping <br />Water heater <br />Gas 6replace <br />Gas range <br />Clo�hes dryer <br />Ran9e hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TA% CODE IS ]705 <br />I hereby centdy ihat I have mad and examined this apphcation and know ihe seme to be irue and corred. All provisions ol laws and <br />ordinaces govemmg Ihis rype ol work will be complied with whether specified herein or not The granting of a permit does not presume <br />to gwe authonry to violate or cancel lhe prowsion of any other s�ate or local law tegulatmg construction or the performence of <br />construction That I am authonzed by the owner of this property to perform the work for which eppGcation rs matle and I comply with the <br />State Cont�actors Law 1827 RCW and 296200 WAC <br />k'r:l�lit�'f_- _ �'/� •G'�: <br />