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SITE ADDRESS <br />LOT N0. <br />(�,NNih � V��i <br />r <br />PERMIT APPLICATIOnI <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 />E. <br />BLOCK <br />��SiE.L <br />PARCEL TAX I.D. N <br />TRACT OR SUBDIVISION # <br />TENANT NAME CONTACTkOR PERMIT � PHONE <br />E-MAIL <br />NTRA �� � <br />CONTR. LICENSE # J.,. �_ S� J <br />f�, �. <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />8alhtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Waler healer <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />HEATSOURCE <br />Electric �Gas Other <br />�� �� <br />NO. I <br />� Z _� -o$' <br />�- a383 <br />CONTRA�T PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />1'�'aler heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 1705 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. Ail provisions ot laws and <br />ordinaces governing this lype of work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />lo give aulhority lo violate or cancel lhe provision o( any other state or local law regulating wnsWction or the performance of <br />construction. Thal I am aulhorized by lhe owner of lhis property to periorm the work for which application is made and I comply with lhe <br />Slat�e Co�nlJ aclors Law 18./27 RCW and 29G.200 WAC. <br />�" 'Y7 ///1 c-YY��,i iX. _ /� • �l- d�j <br />