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SITE <br />LOT NO. <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVE:RETT. WA 98201 <br />425-257-8810 — FAX 425-257-8P57 — mm.everettwa.org <br />APPLICATIONS ARF ACCEPT ED FROM a frill TO 4 PM <br />PARV;EL TAX I.D. llPERMIT # <br />ID Su/G�er:%{lal,l�w 2 HccLo27rc 16L�1%-Q <br />7— BLOCK RACT riR SUBDIVISION # <br />ell eq(Wlt- <br />CUNTNAU r Vn'�� iry�MA/ <br />CONTR. LICENSE # !�5( nn <br />USE OF _BUILDING <br />ockII — <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Root drains <br />Other <br />r <br />FOR PERMIT <br />77- <br />g77-7SS-�Y <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric _. Gas _ Other � <br />(hetone( Ie%"er51Jh <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other= <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />dinates goverm this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />or <br />or give aulho ity t wet a or cancel the provision of any other state or local law regulating construction or the performance of <br />conslructi T authorized by the owner of this property to pe dfJorm she work for which application is made and I comply with thi <br />State Co } w 18.27 RCW and 296.200 WAC. 2 / i. <br />,,L -F <br />