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SITE ADDRESS <br />LOT NO. <br />pESC. <br />CON7RACTOR� p <br />' /J� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />f <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 42rr257-8857 - wnvw.evetettwa.o�9 <br />APPIJCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK I 7RACT <br />�P4L\`�c�S� <br />�v � a e.'t'1 <br />PARCEL TAX I.D. N <br />WORK DESCRIPTION <br />% enu�rr ����1ucr�rtf' "� ?{�r'� r� {���ei'a�%n , � <br />NO. I TYPE OF FIX7UR[ OR ITEM <br />Toilet <br />Bathtub <br />Lavarory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dlshwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbadmop/etc.) <br />Backfiow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Rool drains <br />Olher <br />O l� LOb <br />PHONE <br />-ri'i , � �5 2 - c��l OC_, <br />zz _ "1 � b�l � <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A1C — air handling units <br />Forc^d air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clotl�es dryer <br />Rangehood <br />Exhaus!�an <br />Heat �wmp <br />Unit healer <br />Boiltr <br />Rehigerabon <br />Woodstove <br />Other <br />CITY OF EVERE7T LOCAL SAlES TA% CODE IS �105 <br />i herehy ceri6fy fhat I have read and examined this application and know tlie same to be Que and correct. All provisions ol lavn and <br />ordinaces governing this type ot work will be comptied with whether specified herein a not The grenting of a permrt does not presume <br />to grve autfioriry lo violate or cancel tt�e provision of any olher state or local law regulating construction a Cie pedormance of <br />conshuction. That I am authorized by the owner ot this property ro pertam the wak for which application is made and 1 compty vnth the <br />State Conha��� Law 1827 RCW /a�pd 96.20-0 WAC. <br />. .��� >%I�,ti. �„n.o ("�-', `,/�d y�0 � <br />—� Date ' 1/ <br />Zi <br />