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SITE ADDRESS <br />LOT NO. <br />TEN.iNT NAME <br />PEaMIT 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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />BLOCK I TRACT <br />CONTACT FOR PERMIT <br />PERMIT # <br />PHONE <br />(�ooD�.�«� � SP�M M,��t—i� 4�5-�`65-9 i o� <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />uu�v�esa� �1�c��ca� st-tzv�ct— '�o"�x ��'49 IZ���� yz5-gSs�lioo <br />CONTR. LICENSE I{ _ _ _^ 9e{p13 <br />USE OF BUILDING <br />�t � AtL <br />HEATSOURCE <br />Eleclric X Gas Other <br />CONTRACT PRICE OF WORK <br />IO�b`.� <br />WORK DESCRIPTION <br />�r�yi4�� oNE (,)�xNA�si FaN � aH (�2�Ct5 a-DiFFt�5E,25 wt %}t- J�SOCl.4%� 17uCTua+�K <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disnosal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drein <br />Grease trap <br />Roof drains <br />Olher <br />NO. � TYPE OF FIXTURE OR ITEM <br />AIC — air handling unils <br />Forced air systems <br />Gas piping <br />Wa'er heater <br />Gas fireplace <br />Gas range <br />Ciothes dryer <br />Range hood <br />cxhaustfan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher ('jR�uS iFFvSE45 <br />ti pVG7'u7vttK <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceriti(y thal I have read and examined lhis app�ication and know lhe same to be true and correct. All provisions of laws and <br />ordinaces governing this lype of rk will be complied with whelher specified here n or not. The granting of a permit does not presume <br />to give aulhority lo violale or nce the provision of any other state or local law reoulati�g consWction or the performance of <br />conslruclion. That I am a ori�y the owner of this property to perform the wodc tor which application is made and I comply wilh the <br />State Contreclors La�y!�8�27�RCW and 296.200 WAC. / / <br />