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SITE ADDRE55 <br />5 /S i� <br />LEGAL LOT N0. <br />DESC. <br />OWNER <br />She�1 � lian � <br />TENANT NAME <br />CONTR. L�CENSE # <br />USE OFBUILDING <br />WORK DESCRIPTION <br />�, <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-6857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />�n <br />e/'sar� <br />v � <br />NO. � TYPE OF FIXTURE OR ITEM <br />� Toilet <br />BalhWb <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Waler healer <br />Sink (service/bar/mop/elc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other _ <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />CONTACT FOR PERMIT <br />� <br />PHONE <br />R'�ao J <br />PERMIT # <br />M 70�-� <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric Gas Olher <br />N0. 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 />Rar�ge hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY uF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify thal I have read and examined th's applicalion and know the same to be lrue and ccrrect. All provisions of laws and <br />ordinaces governing lhis type o( work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority le violate or cancel the provision ot any olher state or local law reg��ating construction or the peAortnance of <br />construction. That I am authorized by the owner of this property to perform the work tor which application is made and I comply with the <br />State Conlractors Law 1827 RCW and 296.200 WAC. � <br />