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SITE ADDRE33 <br />� D .� <br />LEGA LOT NO. <br />DESC. <br />� n•i � <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wuvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM T041�M <br />PARCEL TAX I.D. # <br />BLOCK TRACT OR 8UBdVISION i <br />TENANTNAME CONTACT <br />3� l� 1J� l s 'I j� � <br />�� t�Y�'� i N (mvt S/�(.f� ADDRE33 <br />CONiR IJCEN3E i SLL, lA M N� � a"'� C'D <br />USE OF BUILDING <br />� , <br />; Ns lC• <br />JSs��f s� �IG <br />1► �-ia—i v <br />PERMR 1t <br />"11p l 1 -C�r�N <br />PHONE o49�,a_'77 <br />7 <br />c�9,<<z <br />y1s-433-96y{� <br />; 11 c�w,n�.�o, v. .Co•+1 <br />/C PH�N Lc1 q , � <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Eledric _ Gas _ Other � � C� �v <br />WORKDESCRIPTION1h3�r�c.,},or oF ,2—Neos�Ch�v��� ��fj�e� S�a�LS <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />KHchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbadmop/etc.) <br />Badcflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYFE OF FIXTURE OR ITEM <br />A/C - air handling uniffi <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Renge hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigerdtion <br />Woodstove <br />Other �„��Q�_ <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3706 <br />I hereby certify lhat I have read and examined this application and know thR same to be We and cortecL All provisions of laws and <br />oidinanoes gaveming this type of woiic will be complied with whether specified herein or not. The granting of a pertnit does not presume <br />ta give authority to violate or cancel the provision of any other state or local law 2gulaling construdion or the performance of <br />consWclion. That I am authorized by the owner of lhis property to perform the xro�lc forwhich applicatian is made and I comply with the <br />State Conlradors Law 19,77 RC �nd 296.200 WAC. <br />�� -'/rZ 77'��� <br />I�� <br />