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SI7E ADDRESS <br />� <br />� h�. I�ed�« <br />TENANTNAME <br />PERMIT APPLICATIGy <br />CITY OF EVERE�T PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FRONI 8 AM TO 4 PM <br />�VNrf' ff� <br />BLOCK � u <br />Cc; �, <br />T I� e Tr e c� w o v �� <br />N RACT <br />Tl, e Ti, e d ��, �t y C_ �: r�� <br />CONTR. LILENSE N 1 �` w <br />7- 2� {� l� . <br />PARCEL TAX I.D. # PERMIT # <br />.�¢�05U6c�c 3oz Z O�_ ' _ <br />TRACT OR SUBDIVISION N ,�� n-li Z�-Q <br />�¢�` , � ,�.`. nn -'� LI <br />� <br />AO�� CITY2IP Py� SE,3 .J 3-`� IGO <br />Po�3 3oiy LVerei-F WQ R�Y.�u3 <br />CONTACT FOR PERMIT <br />i{Gt�y Trzciu�rxy <br />A����— <br />P c� rjoX 3oi�l <br />151K� <br />IS� 30 � - �r/o0 <br />E•MAIL <br />Evc�relt %$ZDi <br />USE OF BUILDING S lN�x.;: �'/}Mi�y � � HEAT SOURCE ✓CONTRACT PRICE OF WORK <br />Qc� S 1� e, r�. � I _ Eleclric Gas� Other / SQ �(jQ _�� <br />WGRK DESCRIPTION <br />R U t 1 d N��,J i� b 1� � <br />� <br />�1 <br />TYPE OF FI%TURE OR ITcM <br />Toilet <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwashcr <br />Cblhes washer <br />Waler heater <br />Sink (servicelbar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />r�S.riZ� +�� . <br />S�_' �� �� <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas rango <br />Clolhes dryer <br />Range hood <br />Exhaust lan <br />Heal pump <br />Unit heater <br />Boilor <br />Refrigeralion <br />Woodslave <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby ceriti(y lhal I have read and examined this applicalion and know Ihe same to 5e tru� and correcL All provisions o( laws and <br />ordinaces c�overning lhis lype o( work will be complied wilh whelhur specified herein or noL The granlinc� of a permil does not presume <br />lo give auUiority Ic violate or cancel Ihe provision of any olher slale or local law regulatiny construclion or lhe pedormance of <br />construction. Thal I am authorized by ihe avner of Ihis property lo perfurm the work for which application is mzde and I comply wilh the <br />State CoNraclors Law 18.27 RCW and 296.200 WAC. <br />`�� <br />