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SITE ADDRESS <br />LEGA ' LOT NO. <br />DESC. <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257• 8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />P=IRCEL TAX I.D. M <br />BLOCK � TRACT OR SUBDIVISION N <br />NANT NAME - ONTACT FOR PE IT , PMONE <br />�ornmun�t�j Trrzns-�t I�aeBra�r�, �►'41e� �`�Qr. <br />E-MAIL, <br />cvninnciun �T _ <br />� <br />CONTR. LICENSE 7F . <br />�a �du--�d <br />pro �cd Ovtce -I�tz. SucQssiul b�dder' hct5 %.n <br />USE OF BUILDING � HEAT SOURCE <br />�,(,S -�w 1 f� ��T0.11� I _, Eleclric _ Gas _ Other N/A' <br />WORK DESCRIPTION �ns-{-�`� '�-� �°� �R_T ��IUYLS � YL <br />s.� �L-�-t�-�:�-�t. 90'/. p1a,� �--t <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Waler heater <br />Sink (servicefoadmop/etc.) <br />Backflow prevEnler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other _ <br />-7155 <br />CONTRACT PRICE OF WORK <br />i � <br />`lfi►�j C3F' EVP.1'G-�-f' <br />�o�r rev►�c.v <br />NO. I TYPE OF FIX7LRE OR ITEM <br />AIC - air handling units <br />Forced air-ystems <br />Gas piping <br />Water heater <br />Gas fireplace <br />�as range <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woaistove <br />0!her <br />CITY OF EVERETT LOCAL SALES SAX CODE IS 3705 <br />I hereby cerli(y thal I have read and examined lhis application and know lhe same lo be true and correct. All provisions of laws and <br />ordinances governing lhis type of work will be complied with whelher specified herein or nol. The granting oF a permit does not presume <br />to give authority lo violate or czncel the provision of any other state or Iocal law regulaling construction or the perfortnance of <br />construclion. That I am authorized by lhe owner of lhis property to pertortn the work for which applicalion is made and I compty with the <br />State Contradbrs Law_d8.27 RCW and 296 .70 WAC. <br />� �p c�� �u <br />i Agent Date /2 <br />� <br />