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SITE ADDRESS <br />:'v:-��� <br />L[GA LOT NO. <br />P�tRMIT APPLICATIGN <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 />� V�� <br />BLOCK TRACT <br />PARCEL TAX I.D. # <br />i-�o 06 <br />PERMIT # <br />•�,9n1� �i/r lI ��>Y�'o d <br />TENANTNAME CONTACTFORPERMIT PHONE <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />e'Y1�G�, �UA � U�tS /Y.J(� ADDRESS 7� ZJ fj <br />WORK DESCRIPTION <br />NO. I TYPE OF F�X?URE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />I<ilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />Sink (service/bar/moplelcJ <br />Backflow preventer <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other _ <br />HEAT SOURCE <br />�Electric _ Gas _ Olher <br />PMONE <br />Zs33! �a77 <br />CONTRACT PRICE OF WORK <br />..�,OBD.� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />,Gas pipinc� <br />— Waterheater �\U� <br />Gas tireplace I <br />Gas range <br />r Clolhes dryer �, � <br />,Range hood <br />Ezhauslfan <br />_ Heal pump / i <br />Unil healer <br />_ Boiler 2� <br />_ Re(rigeration �, 'r <br />Woodstove <br />`, , <br />_ Olhar � �� <br />CITY OF EVERETT LOCAL SALES TAX CODE 1 3105 <br />I hereby cerili(y lhat I have read and examined lhis application and know the same to be lrue and correct. All provisions o( laws and <br />ordinaces governing lhis rype o( work will be complied wilh whether specified herein or nol The granting of a permil does not presume <br />to give aulhority lo violate or cancel the provision of any other state or local law rec�ulatinc� constructiun or the performance of <br />conslruclion. That I am authorized by lho owner o( this property to periorm the work for which application is made and I wmply with the <br />Slate Contr� or aw 18.27 R/� and 296.200 WAC. <br />/r�' . - - - - l.-� (�1. / � � e t <br />