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SITE ADDRES� <br />iv v <br />LEGAL LOTI:O. <br />D[SC. <br />OWNER ��_�� <br />-i"' � <br />TENANTNAME <br />T A T � <br />`JI�I.U�I'�l.l i�/l <br />CONTR. LILENSE / �n <br />/t <br />USE OF BUILDING <br />�w�ol�x <br />WORK DESCRIPTION <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, Eb`ERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wvnv.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM T04 PM <br />C�� PARCEL TAX I.D. M P���/��a D� � <br />�/ <br />TRACT OR SUBDIVISION 1� <br />ADORESS `Q I � <br />��� 2�i�20�2 !�-. <br />CONTACT FOR PERMIT <br />! �/L �-�-r� <br />� �o� ��p1��,.r�; <br />r.� P�ki t3, ✓�a,� <br />�— HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Eleciric _� Gas _ Olher � �� r lY ��/ • <br />1-��ta�! a 1����t j�u�d.�-v � at dz-�oZ� :w� �, <br />`rit ����2� ✓l�_ ai , d�a i2�11.��. D �� ��rLi�� -t� b1- pla� <br />7,0��1�-iw ��OVL� 5q�lod� . <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen smk 8 disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (servicelbadmopletc. ) <br />Backllow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heatcr <br />Gas Greplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAl( CODE IS J705 <br />I hereby certify that I have read and examined this application and know the same to be �rue and c�rrect. All provisions of laws and <br />ordinances goveming this type o( work will be complied with whether specfied herein or not. ihe granting of a permit does not presume <br />fo grve authonty to v�olate or cancel the provision of any other stale or wcal law regulaling conslruction or �he performance of <br />construction. That I am authonzed by the owner of ihls property to perform ihe vrork for which applicallon is made and I comply wilh the <br />State Contractors Law 1B.?7 RCW and 296 200 VJAC. , � <br />�% <br />c.un� <br />