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SITE ADDRESS <br />LEGAL LOT NO. <br />DESC. 2 � <br />L � I �� ��� <br />TENANTNAN <br />CONTR. LICENSE # <br />USE OF BUILDING <br />I���� <br />WORK DESCRIPTICiN <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, VVA 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. A <br />G� � � < <br />BLOCK TRACT OR SUBDIVISION # ` <br />% <br />ADURESS <br />�a� c���� <br />ICONTACT FOR PERMIT <br />5����� � <br />l.� � i �..� i� <br />C� <br />PLUMBING <br />NO. I TYPE OF FIXTURE Oft ITEM <br />Toilel <br />BalhWb <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Waler heater <br />Sink (service/bar/mop/elc.) <br />BackOow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />9 �2z—O� <br />PERMI7 p <br />�IZS- <br />1 01V1 `7''�7 - l7� <br />PHQNE l.� jS- iS-4 I��S— <br />G�'�• <br />I� I _ 1.11 rlur rnv�.c <br />� %� ) <br />�JIO���LJc��� L 1% ��LU � L.�2-J <br />HEATSOURCE <br />Eleciric � Gas _ Other <br />CONTRACT PRICE OF WORK <br />/-. �x� <br />1� (�S"_� — <br />N0. I TYPE OF FIKTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />i hereby ceritify ihat I have read and examined this application and know the same lo be lrue and correct All provisions of laws and <br />ordinaces goveming this type of work will be complied wilh whether specified herein or noL The granting of a permit does nol preswne <br />to give aulhority to vioiate or cancel the provision o( any olher state or local law regulaling conslruction or lhe pertoimance of <br />conslruction. That I am aulhorized by the owner of this property to per(orm lhe work for which application is made and I comply wilh Ihe <br />State Conlractors Law 18.27 RCW and 296.200 WAC. <br />�� ,�--, �- % •�� - C � <br />