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SITE ADDRESS <br />5y �z� <br />P�RMIT APPLICATI(�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www•everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />� <br />03 -��� <br />LEGAL LOT NO. f BLOCK TRACT OR SUBDIVISION # <br />DESC. I I iO L� UZ�L �iC-� Gn`� — <br />OYJNER ADDRESS CITYIZIP PHONE ��S <br />SFlN�uCL j�1u7f 23$il f'�o�E��ce A�� ds MO���E °)gz�z 39S• l�Sz_ <br />TENANTNAME I CONTACTFORPERMIT PHONE <br />� <br />CONTR. LICEN�� # ��cti�n � � <br />USE OF BUILDING <br />5 I"4� <br />WORK DESCRIPTION �ICC-MO D�L <br />NO. I TYPE OF FIXTURE OR ITEM <br />HEAT SOURCE <br />_ Elecldc � Gas _ Olher <br />N�vSe_ � ��c �1� A��� �f �e� <br />�Toilet <br />Bathtub <br />� Lavatory (wash basin) <br />�Shower <br />Kilchen sink & disposal <br />�_ Dishwasher <br />_� Clothes washer <br />1 Waterhealer �;t, <br />Sink (service/badmop/elcJ�:? t� ^ -t°-` �- <br />_ Back(low preventer � � �ti��.�, <br />Urinal _ <br />Drinking Fountain <br />Floor drain <br />Grease irap <br />Roof drains <br />Olher <br />GONI KAG I PKIGt V1- vauKn <br />% .ri /I'/1/J -- <br />�7�U �.vc/ <br />NO. I ' TYFE OF FIXTURE OR ITEM <br />A/C - air handling units <br />� Forced air systems <br />k Gas piping <br />X Walerhealer <br />Gas tirepiace <br />Gasrange <br />� Clothes dryer <br />� Range hood <br />�_ Exhaust (an <br />_ Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 31�5 <br />I hereby ceritify lhal I have read and examined lhis application and know the same lo be lrue and correcl. All provisions o( laws and <br />ordinaces governing this type of work wil� bo complied wilh whelher specified herein or noL The granling of a permit does nol presume <br />lo give aulhorily lo violate or cancel Ihe provision of any olher slate or local law regulating cunstruction or the perTormance of <br />conslr tion. That I am authorized by the owner of this property to perform the work (or which applicalion is made and I comply wilh lhe <br />State ntraclors La 18.27 RCW and 296.200 WAC. <br />.. �'I;� '3��iln� <br />,a <br />