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SITE ADDRE55 <br />� _) CJ �J LD <br />LEGAL . LOTNO.� <br />DESC. <br />TENANTNAME <br />i cRMIT APPLICATI� N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEk�TT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C% G7�� (l " <br />�P�lY1�T�-� �AI <br />BLOCK <br />COA'TRACTOR L. /1m,r-yrp <br />11�(' � •�'—'- <br />CONTR. LICENSE M <br />USE OF BUILDING <br />WORK 0 SC` F RIPTION � �O 1 <br />l� <br />(�DLe� I <br />NO. I TYPE OF FIXTURE OR 17EM <br />.� Toilel <br />�Bathtub <br />Lavatory (wash basin) <br />� Shower <br />_� Kltchen sink 8 disposal <br />_L Dishwasher <br />_(__ Clothes washer <br />_ Leundry tray <br />__ Sink (servicelbar/mop/etc ) <br />Backllow preventer <br />Urinel <br />^ Diinking Fountain <br />Floor drain <br />_ Gtease trep <br />Roo(drains � <br />Othcr <br />PARCEL TAX I.D. • <br />L�. <br />TFiACT <br />UDRE55 CITYRIF <br />=� Q9'f� ��(/E �joz � <br />CONTACT FOR PERMIT <br />tJ/G-! �LQ ✓"� '�v <br />, PERMIT � <br />'. [/ � % <br />i' <br />PHONE � <br />�� ti <br />PHONE <br />�--�su _� <br />pDDRESS v CITYRIP ' /'P� N��; <br />�a• <br />9s�s� 5�� �C/�/o� (a,��'�v� <br />HEATSOURCE <br />_ Electric ✓ Gas _ Other <br />� 5�70 <br />w� <br />CONTRACT PRICE OF WORK <br />ND. I TYPE CF FIXTURE OR ITEM <br />A/G — atr handung unns <br />Forced air systems <br />Ges piping <br />Water heater <br />1_ Ges hreplace <br />,L Gas range <br />1 Clolhes dryer <br />��Renge hood <br />Exheuslfan <br />_ Heetpump <br />Unit heater <br />'� Boiler <br />_. Refrigeration <br />Woods�ove <br />Other <br />CITY OF EVERETT LOCAL SALES TA% COOE 19 ]705 <br />I hereby cenlily tnat I have read end exemined Ihis application end know the same lo Ge Irue end co�rect. All provisions ol laws and <br />ordinacAs goveming Ihis type of work will be complied wilh whether specified herein ur not. The grecting ol e permlt coes nol presume <br />to give outhority to violate or cancel the provlsion ol any other slate or local law regulating construction ar the perlormance of <br />construdion. That I am eulhonzed by the owner ol this property ro peAorm the work for which epplication is made end I wmply wilh tha <br />State Contractors Lew 1827 RCW and 296.20J WAC <br />; �;)l,�:t� <br />� ' <br />