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SITE ADDRESS � D � <br />E V �fi eTT <br />LEGA LOTNO. , <br />ERMIT APPLICATl�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.averettwa.org <br />APPLICATIONS l.RE ACCEPTED FROM 8 AM TO 4 PM <br />3 F�emiN�< <br />u�� gSav3 <br />BLOCK <br />PARCEL TAX I.D. # <br />I�NO rnyA� �03� ,G�em; �v� <br />TENANTNAME coNTncrFoecrenm�� <br />' �.^ �V(7,f/Ci"• ,r`� , �/r�k7i1 ��CO�r i� <br />.. � <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />ADDRESS <br />Or,v/7e/i' <br />WORK DESCRIPTION <br />/ <br />�, , J <br />t�� ` <br />HEAT SOURCE <br />_Electric kGas <br />(�?�Lr �-�' _ <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet � <br />Bathtub ✓ <br />Lavatory (wash basin) <br />Shower�� <br />Kilchen sink & disposal / <br />Dishwashei <br />Clolhes washer� <br />iVateclwater ✓ <br />Sink (service/badmop/etc.) <br />Back(low prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />PHONE <br />• (ya y� 8�0., <br />. <br />CITY2IP PHONE <br />1 1' e;:. � � ��..�' � <br />. <br />CONTRACT PRICE OF WORK <br />i s" c.�' ��':.y �-p ! F G <br />Other , . _ „ _ . _ ., �, <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />� Forced air systems <br />Gas piping <br />Water heater <br />Z Gas fireplace <br />� Gas range <br />/ Clothes dryer <br />� Range hood <br />!� Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined ihis application and know the same to be true and correct. All provisions of laws and <br />orclinaces governing this type of work will be complied wilh whether specifie� herein or nol. The granling of a permit does not presume <br />lo give aulhority lo violate or cancei lhe provision ot any other state or loca� 12w regulaling construclion or the performance o( <br />construction. That I am aulhorized by the owner of this property to perform the work for which application is made and I comply with ihe <br />Slate Contracfors Law 18 ?7 R['W and 296200 WAC. <br />o( o( O ,(j <br />Dat � � <br />