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l — <br />� PERMIT APPLICATI(�N <br />CITY OF �VERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERFTT, WA 98201 <br />425-257-8810 — FAX 425 257-8857 — www.everettwa.org <br />51TE ADURESS <br />�3033 <br />L[GAL LOT NO/ <br />DESC ( � <br />TENANTHAME <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�m csn�`i La <br />BLOCN <br />CONTRACTOR L. /7m,e.-N rn <br />.[�LY u ..�..� <br />CONTR. LICENSE 11c <br />J� <br />USE OF BUILDING <br />WORK DESC_ RIPTION <br />c(��j'�jlJU� � Z � � <br />NO. I TYPE OF FIXTURE OR ITEM <br />� Toilet <br />�BetMub <br />Lavatory (wash basm) <br />Shower <br />!_ Kitchen sink 8 disposal <br />_'/ , Drshwasher <br />_ / Clothes wasfier <br />� Laundry tray <br />Sink (serncelbadmopletc ) <br />BackOow preventer <br />Unnal <br />Dnnkmg Fountam <br />Floor drain <br />Greasetrep <br />Roof drains <br />Other <br />PARCEL TAX I.D. # <br />TRACT <br />�pDDRESS <br />9.qf� ��UE" <br />CONTACT FOR PERMIT <br />�%P���,le,c�c �/ <br />l �� <br />PHONE <br />%]� �� '7S�—�S�O <br />pDDRESS " CITY2IP PHON <br />s�zs-�s3 <br />9�� y � �v�io� �.��vv� <br />/7" /� <br />�/•�- <br />— HEAT SOURCE I CONTRACT PRICE OF WORK <br />Fleciric ✓ Gas _ Olher <br />�.�)1��� � <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C - air hand6ng units <br />T Forced eh sys�ems <br />i� , Gas pipmg <br />I Water heater <br />_/ � Gas hreplace <br />� Gasrange <br />. (� Clothes dryer <br />1 Range hood <br />_� _ Exhaustlan <br />Heat pump <br />Unit heater <br />Boller <br />Relrigeratwn <br />Woodstove <br />Other <br />CI7Y OF EVERETT LOCAL SALES TA7( CODE IS J105 <br />II hereby cerilily Ihat I have read and exammed �his applicafion and know lhe snme to be lrue and correct All provisions ol lav+s end <br />ordinaces governinq this type of work w�ll be complied with whether specified herein or not The grenting uf a permit does not presume <br />I to grve authonly to wolate or cancel the provision ol any other state or local law regulating conslrudion or the perlormance of <br />� construction That I am author¢ed by the owner of this property to perform the work for which epplica6on is mede and 1 comply with lhe <br />� Stata Contractors L w 7 27 RCW and 206.200 WAC � <br />� � <br />i <br />' Signalure of OwnedCo ira t <br />t._ -------...... __. __.__ <br />