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SITE ADDRESS <br />LEGAL LOT NO. <br />DESC. <br />P�RMIT APPLICATIO�v <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 8 AM TO 4 PM <br />BLOCK <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />�--0��-t( <br />PERMIT # <br />c��n A-003 <br />TENANTNAME . � CONTACTFORPERMIT PHONE NZ$'3 B�OIZ� <br />PS,�« <br />�R. LICENSE # <br />USE OF BUILDI <br />WORK DESCRIPTION Q� 30 Atstr <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BatMub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />BackFlow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Greaselrap <br />Roof drains <br />Other <br />HEATSOURCE <br />Electric _ Gas _ Other <br />Nu-3gb'- o �ay <br />CONTRACT PRICE OF WORK <br />�3, 03 v ,'� <br />� I � _ /__m.� <br />NO. I TYPE OF FIXTURE OR ITEM <br />P;/C — air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gasrange <br />Clothes dryer . <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration � <br />Woodsl�o+ve ,^ <br />�lhet Fiw C.� rI11RIBr <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby certify thal I have read and examined this applicalion and know lhe same lo be lrue and correct. All provisions of laws and <br />ordinances governing lhis type of wo�k will be complied with whether specified herein or not. The granting of a permit does nol presume <br />to give authority to violate or cancel �he provision of any other state or Iocai law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property lo periorm the work for which applicalion is made and I comply wilh the <br />Slate Contractors Law 18.27 RCW and 296200 WAC. <br />l A/[!Th __�r' 1.�.L_ `/ 6/' I II <br />Sig a ure of nedCorliractor/Authonzed Agent Dale � <br />