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SITE AGDRESS <br />LOT NO. <br />TENANTNAME <br />CONTR. LICENSE p <br />USE OF BUILDING <br />WORK DESCRIPTION <br />i�� ���� ,�-e <br />PEaMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FA\ 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FRGM 8 AM TO 4 PM <br />S��« 175 <br />t %' <br />BLOCK <br />.,, Il Ll l <br />PARCEI TAX I.D. # <br />TRACT OR SUBDIVISION # <br />CONTACT FOR PERMIT <br />� /<: � � <br />�� t �,�� <br />�I�N G� >(�OiCSS }nLADDRESS �)/3 �� <br />v <br />..r / <br />�UN�I I� � <br />i�� , ��-t- �- ��� J <br />NO. I TYPE OF FIXTURE OR ITEM <br />� Toilel <br />Bathtub <br />_j_ Lavalory (wash basin) <br />Shower <br />Kitchen sinY & disposal <br />Dishv+asher <br />Clolhes washer <br />J Waterheater <br />_ Sink (service/badmople!c.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Rouf drains <br />Other <br />HEATSOURCE <br />PERMIT # <br />�a �U 7 -GOS <br />PHONE�S� 3 �5 � �`/ � <br />�.�y � <br />S�,m�tf� <br />_ Eleclric _ Gas _ Olher <br />�ZS.ib�?4' �� �.i <br />CONTRACT PRICE OF WORK <br />cJ <br />�no� � <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas (ireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhausl (an <br />Heal pump <br />Unil healer <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined lhis application and know ihe same lo be lrue and correcl. All provisions of laws and <br />ordinaces �oveminc� this tyue ot work will be complied with whether specified herein or noL The granting of a permil does not presume <br />lo give aulhoriry lo violate or cancel the provision of any other stale or local law regulating construction or the periormance of <br />construction. That I am authorized by the owner of Ihis property to per(orm lhe work for which application is made and I comply with the <br />Stale Conlraclors Law 18.27 RCW nd 29�Fk'b0 WAC. <br />—, <br />' ;' �/ 'tit�' %`/�-�S� <br />