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SITE ADDRESS <br />LOT N0. <br />P�RI'JIIT APPLICATI�N <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 a��g-Q <br />BLOCK I TRACT <br />PARCEL TAX I.D. # <br />PERMIT 3i <br />�ft'7�:1 —�� <br />(�� � / 1 q <br />:JIC��� �a+�{ -}�u- l�c�� '��5� l�Yuhi"1-P �nlir ��0�� � ��d�- <br />� � <br />TF.NANT NAME CONTACT FOR PERMIT PHONE <br />-1 „c�C, � JC Y � � <br />CONTRACTOR ((��i,i; ��� �f ADDRESS 1 �� \'��'F � �; �� CITY2IP `YS;,lS?� PHON �La)� �I� `t�S �� <br />CONTR. LICENSE il <br />USE OF BUILDING � HEAT SOURCE I CONTRACT PRICE OF w�RK <br />n;r, L I k' Electric _ Gas _ Other <br />WORK DESCRIPTION <br />/ <br />�' �x �� �z <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhluh <br />Lavatory (v;ash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (serviceNar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Irap <br />Root drains <br />Olher <br />� <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />�t Water heater <br />Gas fireplace <br />Gas range <br />� Clothes dryer <br />.t Range hood <br />Exhaustfan <br />Heal pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodslove <br />O!har <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify lhat I have read and examined lhis application and 4:now the same lo be true and correcl All provisions of laws and <br />ordinaces goveming this type of work �vill be complied with whefher speci(ied herein or not. The granting of a permit does not presume <br />to give aulhority lo violale or cancel lhe provision of any other stale or local law regulating consWction or the performance o( <br />r.onstruction. That I am aulhorized by lho owner of this property to perform the �vork (or which application is made and I comply wilh lhe <br />Slate Contreclors Law 18.27 RCW and 296.200 b74C. <br />• Y� i . �� .. . ..., r . Y' , r4 <br />I/ 7 <br />