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IT APPLICA' <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 />SITE ADDRESS <br />r � � <br />LEGA LOTJiO. <br />DESC. � O <br />OWNER <br />�Htk��,d� f} <br />TENANTNAME <br />r <br />9 �+ <'• t' <br />�J _ _'� . <br />Dw�� <br />CONTR. LICENSE N <br />USE OF BUILDING <br />N� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�-i o �2 <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 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 drafn <br />Grease trap <br />Roof dralns <br />Olher <br />PARCEL TAX I.D.1l <br />TRACT OR SUBDMSION A <br />ADD SS ' , <br />7 29 �lesr �� ew 4, <br />r� i � �Fi.EMIN G sr � <br />ICONTACT FOR PERMR <br />/�-�t�5a.r� ,�,,,,.F� <br />—�as�rt�—�� `—�rtvm <br /><<���c', 't <br />HEAT SOURCE <br />_ Electric ,�, Gas _ Other <br />1� `. °'tb --�� <br />Pl.��l/'ODt7 <br />PERMIT i <br />C o�// - d0 <br />a��3 <br />PHONE�� 33O Voo2 <br />, , <br />:. �:.� <br />CONTRACT PRICE OF WoliR <br />NO. I TYPE OF FIXlURE OR 17EM <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 />E�austfan <br />Heat pump <br />Unit heater <br />Bofler <br />Refigeratlon <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby ceritlfy that I have read and examined this application and know the same to be true and correct. All proWsions oi laws and <br />ordinaces goveming this type of work will be complied with whether specHled herein ar not. The grantl�g of a pertnit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulaUng construcdon or fhe pertortnance of <br />construction. That I am aulhorized by the owner of this property to perfortn the work for which application Is made and I comply with the <br />State Contractors Law 78.27 Rf,1Cl�and 296.200 WAC. � � <br />`'2 <br />