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SITE ADDRESS <br />LO7 NO. <br />� _ i <br />�x�v 1-1c,u� �- <br />CONTRACTOR <br />CONTR. LICENSE t! <br />USE OF BUILDING <br />P�RMIT APPLtCATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�adu�va <br />BLOCK <br />c:a�9 ��;-a,.tU\ <br />WUR DESCRIPTION <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilo! <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/elc.) <br />_ Backflow preventer <br />Urinal <br />Drinking Fountain <br />Ploor drain <br />Grease trap <br />Roof drains <br />Other <br />PARCEL TAX I.D. JF <br />TRACT <br />; 9�, n <br />qTYlZIP <br />�✓I41lI!)CJ� W� <br />CONTACT FOR PERMIT <br />i <br />� laV `q i-�va"j � <br />HEATSOURCE <br />=ElccUic _ Gas _ Olhr.r <br />Z' <br />CITY2IP PHONE <br />CONTRACT PRICE OF WORK <br />:HANICAL <br />N0. I TYPE OF FIXTURE OR ITEM <br />_ M'C — air handling unils <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas ranc�e <br />Clolhes dryer <br />Range hood <br />Exhausl (an <br />He3l pump <br />Unil healer <br />Boiler <br />Refrigeration <br />Waodstove <br />Olher <br />CITY OF EVER[TT LOCAL SALES TAX CODE IS 3105 <br />I hereby centify thal I have read and examined this application and know ihe same lo be true and correcL All provisions of laws and <br />ordinaces goveming Ihis type o( work will be complied wilh whether specified herein or not. The granting of a permi: does nol presume <br />to give aulhority lo violale nr cancel the provision of any olher state or loca� law regulating consWction or lhe pedormance of <br />consiruclion. Thal I am aulhorized by the owner of lhis property to peAorm the �ti�ork for which application is made and I comply �vilh Ihe <br />Stale Conlraclors Law 18.27 RCN.� and 296200 WAC. <br />Signature o( OwnedConlractor/Authonzed Ac�ent Dale ,1 � <br />