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Q <br />`�. <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.everettwa.org <br />SITE ADDRE£S <br />L1 , <br />f��.�L �� lr�it',it(� <br />LEGALI LOT NO. <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />BLOCK <br />TENANT NA�AE <br />..I ���-�1-� ��'.��1.f_ <br />CONTRACTOR <br />I. ' , „ ��i�{,. , " i , <br />CONTR. LICENSE # , � . <br />I C' 7 11 L. ('ll i_ I� � I C' I'� <br />USE OF BUILDING I <br />PARCEL TAX I.D. # <br />TRACT <br />;� �US' 3 <br />P�RMIT # <br />�j J l.' �-' i�' �— L' .� � <br />CONTACT FOR PERMIT PHONE <br />�"�i 1(l_l'l L �',V '.-,_'. A -i,_ .' �I ,. j - C%�'L-�� <br />ADDRESS CITY2IP PHONE <br />�I��. f�l'�. .l_��-��.�1 . .:1� '�; �i � . .i; i; � �..�.i�l <br />HEA? SOURCE CUNTRACT PRICE OF WORK <br />Electric Gas Other -� - ��'`� " <br />WORK DESCRIPTION <br />��11_ �1��•_i�i�,��� r�... ���� , ��'�.�11 <br />r <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laundry tray <br />Sink (servicefbar/mopletc.) <br />Backflow prevent2r <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />� Other �,rlAfei L�N.✓ <br />N0. I TYPE OF FIXTURE OR ITEM <br />NC - air hantlGng unds <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas freplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heatpump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />I hereby ceritify that I have read and er.emined this application and know ihe same to be true and wrrect. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or noL The granting of a permit does not presume <br />to give authonty �o violate or cancel lhe provision of any olher sta�e or local law regulating conslruction or the performance of <br />construction. That I am authorized by�ihe owner of this prc perty to perform ihe work for which application is made and I comply with ihe <br />State,6on�racrors Law 1b.� RCW�1�d 296200 WAC. <br />�3,.�'�DoG� <br />