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r <br />P�RMIT APPLICATIUN <br />CITY �� EVERETT PERMIT SERVICES <br />32G0 CEDAR STREET, E'JERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE HCCEPTED FRQM 8 AM TO 4 PM <br />SITE ADDRESS <br />�?oy C�S � <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />Pt�i�:�,A �� <br />TENANT NAME <br />���'� '`i ° <br />CONTR. LICENSE M <br />USE OF BUILDING <br />�� '�" <br />WORK DESCRIPT 0� <br />OLOCK <br />. <br />Np. � TYPE OF FI%TURE OR ITEM <br />Toilet <br />Ba�htub <br />Lavalory (wash basln) <br />Shower <br />Kitchen sink 8 disp.aal <br />Dishwasher <br />Clolhes washer <br />Walor heater <br />Sink (servicoNanmcp/olc.) <br />Backflow provonter <br />Urinal <br />Drinking Founlain <br />Ftoor drain <br />Grease Irap <br />Rool drains <br />Olher <br />PARCEL TAX I.D. N <br />'RAC7 OR SUBDIVISION p <br />EV <br />•�y <br />PHONE <br />E-MAIL <br />PERMIT N <br />,D c,�o�-�u3 <br />�za�3y 3 -3 p <br />HEAT SOURCE y�� � CONTRACT PRICE OF WORK <br />Eleclric Gas Olher <br />NU. I TYPE OF FI%TURE OR ITEM <br />A/C - air handling unils <br />Forced air syslems <br />Gas piping <br />Walor heater <br />Gas fireplace <br />Gasrango <br />Clolhes dryr r <br />Rango hood <br />Exhaustfan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TA% CODE IS J105 <br />I hereby cerilily that I have read and eRamined this applicalion and know the same to be true and correcl. All provisions oi laws anA <br />ordinaces govominc� lhis typo of work will be complied with whether speci(ied herein or not. The granling of a permit does no! presume <br />to give authorily to violate or cancel tho provision o1 any olher state or local law regulaling consWction or lhe performance of <br />conslruction. That I am aulhorized by lhe ownor ot Ihis property to perlortn the work for which application Is made and I comply .vilh the <br />Slato Conlractors Law 18.27 RCW and 296.200 �YAC. <br />—/9— �' 7 <br />Dale 1 /i <br />� <br />