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SITE ADDRES5 <br />1 <br />P`rRMIT APPLICATI(�N <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 />q ��, � PARCEL TAX I.D. # <br />.�ifLCiT WA, <br />LEGAL� LOTNO. BLOCK <br />DESC. <br />OWNER <br />6Hvir1 � vHN��T-C�fr��S '�`��� <br />TENANTNAME <br />y <br />CONTRACTOR �UME OWNEjZ <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HvN�E/R�S��+� <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 />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />TRACT <br />ADDRESS <br />i��¢ A-L A�'E <br />CONTACT FOR PERMIT <br />ADDRESS <br />HEAT SOURCE <br />_ Eiectric � Gas _ Other <br />PERMIT # <br />✓b�YLE'rt �NA �-Iz5 -35q.33�-! <br />PHONE <br />CITY2IP PHONE <br />�. �i <br />I CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems {:, � �ne <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clathes dryer <br />Range hood � <br />Exhaustfan <br />Heat pump. <br />Unit heater' <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TA7( CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and cortect. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any olher state or local law regulating construcGon or the perfortnance of <br />construction. That I am authorized by the owner of this property to perfomi lhe work for which applicaGon is made and I comply with the <br />State Contractors Law ?8.27 RCW and 296.200 WAC. <br />l,"%��'�/�� ��✓1 ��G� i�' � S - U S <br />