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SITE ADDRESS <br />� � <br />LEGA� LOT NO. <br />F�cRMIT APPLICATIUN <br />C17Y 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 70 4 PM ��,'�� <br />; %� <<<60 � �'ci <br />BLOCK <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION N <br />DESC.f I � . <br />J <br />OWN R ADDRESS CITY/ZIP PHONE <br />/�lc�,�.��% yoase.('�� 31�N <'...(�,�` � `l$'�3 y.��•3i8�olo <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />E•MAIL <br />Z`"6 R <br />CONTF. LICENSE R (_ ��LJ�C�� <br />US= OF BUILDING <br />WORK DESCRIPTION <br />�nlfi��� n ��f'(ri,e"� <br />PLUMBING <br />N0. TYPE OF FIXTURE OR ITEM <br />�—�/ Toilel <br />�y�alhlub <br />Lava�ory (wash b�sin) <br />�� Showcr <br />.ilr.hon sink & Jispos:il <br />I)ISI1W85I1M <br />� C�O�hCS Wi15�1Cf <br />Walcn c�alcr <br />� ✓ Sink (servicclbndmop!ntr..� <br />�ackflow prevenlor <br />Urinal <br />Drinkiny Fountain <br />Floor drain <br />Grease trap <br />Rool dr�ins <br />Other <br />HEAT SOURCE <br />_ Eledric __ Gas _ Olhor <br />CONTRACT PRICE OF WORK <br />ZC� C�k'� � <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ A/C - air handliny units <br />Forcod air systems <br />_ Gas piping <br />Waler hoaler <br />Gas fireplaco <br />Gas rango <br />Cblhes dryer <br />Rangohood <br />Exhausl (an <br />Hoat pump <br />Unit hoater <br />Boiler <br />Refrigeralion <br />Woodslovo <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I horsby coritity Ihal I have read and examined Ihis applicalion and know the same to be truo and correcl All provisions of laws and <br />ordinaces c�ovmning Ihis type of work will be complied with whelher specified herein or noL Tho granting ol a permit does not presume <br />lo qive authority to violate or can�el �he provision of any othor stale or local law rogulaling conslruc�ion or lhe peAormance oi <br />conslruclion. That I am aulhorize 1 by tho ownor of lhis propoAy to poAorm the work for which apptication is made and I comply with Ihe <br />S�ale Conlraclors Law 18.27 RCW and 296.200 WAC. <br />; l �� n.1/�/ `�/,14�0 } <br />