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I <br />F�RIVIIT APPLICATIUN <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 9 AM TO 4 PM ��-�/—D� <br />SITE ADDRESS / 'Y1! � <br />'%�%ID �✓E2 �ti�ElJ w�-' <br />LEGAL LOT NO. BLOCK <br />DESC. <br />OWNER <br />TENANTNAME <br />���� <br />C TRACT R <br />_� <br />CONTR. LICENSE # � <br />USE OF BUILDING <br />TR-��{�J��G. <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION p <br />PERMIT # <br />ACT FOR PERMIT PHONE <br />.,,._ ., ._ _ . .. i�2J - P76- 2��� <br />HEATSOURCE <br />_ Eleclric _ Gas _ Other <br />WORK DESCRIPTION <br />�,� s, � s� �rro � o� 1��u-� u�r�-cic <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilel <br />BalhWb <br />Lavatory (wash basin) <br />Sho�ver <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (service/bar/mop/^.tr,.) <br />Backflow prceentnr <br />Urinal <br />Drinking Fowlain <br />Floor drain <br />�rease trep <br />Roof drains <br />Olher <br />-2 <br />CONTRACT PRICE OF WORK <br />D00 <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handlinc� units <br />Forced air systems <br />Gas piping <br />Waler heate: <br />Gas fireplace <br />Gas range <br />�'olhes dryer <br />hange hood <br />Exhausl fan <br />Heal pump <br />Unit liealer <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify tnat I have read anr+ examined lhis application and f�now the same to be lrue and correcl. All provisions of laws and <br />ordinaces noveminc� Ihis lype of woiY. will be complied wilh whether specifed herein or noL The graNing of a permil does nol presume <br />lo give aulhority to violate er cancel the pruvision of any other slale or local law regulating conslruction or the per(ormance of <br />construdiun. That I am aulhorizer� by Ihe ownr,r of lhis property lu perform the work for which application is made and I comply wilh Uie <br />State Contraclors Law�827 RCW and 296.200 WAC � � <br />�l!g l �a� <br />%` <br />