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SITE ADDRESS <br />� �� CC�� <br />LEGA LOT� <br />I L.�� <br />TENANTNAME <br />I �o1x�t T <br />GONTR. LICENSE # <br />USE OF BUILDING <br />• `r0. L <br />WORK DESCRIP710N <br />PtRMIT APPLICATIC�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, bVA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />'e y��t0�' �pot <br />BLOCK iRACiOR <br />�Cj �—OO L.fi.\ <br />ICONiACT <br />� <br />N <br />� <br />HEATSOURCE <br />PERMIT 7f <br />�a400 �912 -32 <br />1 I � <br />CITYlZIP PHONE � ^ r <br />p .l7 <br />���c�� !��'��' �k 3�3 -'1 i s3 <br />PHONE <br />E-MAIL <br />ll N <br />I CONTRACT PRICE OF WORK <br />[lectric _ Gas _ Olher <br />y�`'Q �'`� �� '���_ <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavafory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />BackOow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease Irap <br />Roof drains <br />Olher <br />�4/G: — <br />�:kL-��� <br />l�� �Gj4/ <br />MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITfEM <br />NC — air handlinc� unils <br />Porced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas rsnge <br />Clolhes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES T/UC CODE IS 3105 <br />I hereby ceriti(y that 1 ha.e read and oxamined this applicalion and know the same to be true and correct. All provisions of laws and <br />ordinaces goveming fhis lype of work will be complied with whe(her specified herein or not. The granting of a pe mil does nol presume <br />to give aulhorily lo vio�atr or cancel lhe provision of any other slale or local law regulating conSWction or the performance of <br />construclion. That I am authorized by the owner of lhis propeAy lo perform the work for which application is made and I wmply with the <br />Stale,Coqiractvrs Law 1$�27 RCW and 29G.200 WAC. <br />