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� <br />PtRMIT APPLICATIVN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8310 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT 11 <br />y� � ����� ��� W1os��-r�o� <br />LEGAL LOTNO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS CI7Y/ZIP PHONE <br />�� v ��. � s � y yo� � ���,�a� �'�.� �-��,e�-� yzs ��-9 �/� � <br />TENANT NAME <br />CONTACT FOR PERMIT <br />PHONE <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />CONTR, UCENSE # <br />USE OF BUILDING � HEAT SOURCE � CONTRACT PRICE OF WORK <br />K Electric �Gas Other <br />WORK DESCRIPTION <br />�i.�ro o , ,..� �/e �-7 �z� � ,� �.:.:wa � � <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />S(nk (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />,D�.�'��,eG� ��d �.�.� <br />NO. � IYPE OF FIXTURE OR ITEM <br />AIC — 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 />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CUDE IS 3705 <br />I hereby ceritify that I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herefn or not. The granting of a pertnit does not presume <br />to give authority to violate or cancel lhe provision of any other state or local law regulating construction or the perfortnance of <br />construction. That I am authorized by the owner of this property to perform the work for which applicaUon is made and I comply wilh the <br />State Con�ctors Law 18.27 RCW and 2�96200 WAC. <br />�c_�vl� �✓(�C�hr,Gj'. /�/y� s.� <br />