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SITE ADDRESS �on <br />_, <br />LEGAL LOT NO. <br />TENANTNAME <br />f <br />—a <br />PERMIT APPLICATION <br />CITY OF E�ERETT 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 />S• �. ��FitG�T <br />BLOCK <br />c��1� ��c <br />�1�/ D�li�{. <br />n��1io�'�c sicn� <br />CONTR. LICENSE tl <br />n���icsco3►�n <br />USE OF BUILDING <br />��7� L <br />WORK DESCRIPTION <br />PARCEL TAX I.D. # <br />2goslSoc <br />H SUBDIVISION il <br />?��o �56�"A'✓E,��• ��al�✓ug <br />CONTACT FOR PERMIT <br />S��v� � <br />E•MAIL <br />�• N� s��>1c�, a�`� <br />_ 98l09 <br />HEATSOURCE <br />Electric _ Gas <br />q � aU ��, <br />�ERMIT # <br />��9��� - �v4 <br />DNE <br />� <br />6 2d2-n7dv <br />?re2u��9�6•aqlS�y�U �1��� <br />ONE <br />C2a6>281-flfvv <br />CONTRACT PRICE OF WORK <br />Other YL 7 %�i�% �` <br />(A/f I/rGL P/✓� SlN6�E %�'!l�F /GGy�1/�✓A%FD �"iyL SIG� DL30G�%y, <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water hea�er <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Roof drains <br />Olher _ <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Fomed air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Heatpump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces govemn this type of work will be complied with whether specified herein or noL The granting of a perm�t does not piesume <br />to give authority t viola� o� cel ihe provision of any other state or local �aw regulating construction or the performance o( <br />construction. Th I am uthor' ed by the owner of ihis propedy to pedorm Ihe vrork tor which application is made and I comply with the <br />Slate Conirac�q s,�ayf 182 CW and 296.200 WAC. <br />9� <br />�� <br />Z <br />