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SITE ADDRESS <br />a��l� <br />LEGAT LOTNO. <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />��RMIT APPLICATIUN <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 T(14 PM <br />vitG /YJ9 I PARCEL TAX I.D. # <br />� BLOCK � TRACT <br />ADDRESS <br />CONTACT FOR PERMIT <br />P-� /���.� �k� <br />ADDRESS <br />/�I �X <br />�,�msp�y�� � Z �6 � � <br />I HEATSOURCE <br />CITY/ZIP <br />Gvc,^c� ��� <br />Eleclric Gas Other <br />PERMIT # <br />x osa�-c,:b <br />PHONE <br />PHONE <br />�s =.�s-s- �.�3� <br />PHONE <br />y<2S =3v3 - �a� � <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION I � �r r� . �`�n � _^_ � 4� 3 ��� ��zL"�„/ - <br />./1�'1� u� ,r�=� -prr�_ ,..---�i <br />� ��� .,<°uQ� ,, <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Laund�y tray <br />Sink (service/bar/mop/etc.) <br />Backilow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greaso lrap <br />Roof drains <br />Other <br />NO. I Tl PE OF FIXTURE OR ITEM <br />A/C — air handiing unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes drycr <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Re(rigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify thal I have read and ezamined this application and know lhe same to be lrue and correct. All provisions of laws and <br />ordinaces goveming this lype oF work will be complied wilh whether specified herein or noL The granting of a permit does not presume <br />lo give authority to violate or cancel the provision of any other state or I�cal law regulating construction or the performance of <br />construction. That I am aulhorized by the owner of this properly to perform the work for which application is made and I comply with the <br />Slale Conlractor�v 18.27 RCW and 296200 WAC. , <br />