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SITE ADQRESS <br />1 % �b f�Y�i� <br />LEGAL LOiNO. <br />DESC. <br />OWNER <br />� �,�. � <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />.�. — — <br />, <br />PtRMIT APPLIC„Ti(��V <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 />A!'PLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� �luQ: <br />BLOCK <br />� <br />� � r'✓� `�'1� <br />� _ , (,�, <br />WORK DFSCRIPTION <br />/y <br />l. �'�D�f �� <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR IT[M <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />6ackflow preventer <br />Urinal <br />�rinking Fountain <br />Floor dr2in <br />Grease trap <br />Roof drains <br />Other <br />PARCEL TAX I.D. # <br />C���i � DOoC� <br />TRACT <br />ADDRESS <br />�-„t,�41��,�ssPs /73c <br />ICONTACT FOR( �PE'' i7 <br />` j Ctc C�o I'�-� �;n S <br />ADDRESS <br />HEAT SOURCE <br />Eleclric Gas Other <br />.5��— <br />CITY/ZIP <br />/�r'QGii54h <br />�i�5. <br />CIN21P <br />/J - � g—tJ <br />tM IT # <br />>:�// -3 <br />t��et/ `�",�D� <br />PHONE <br />�lao. 5%g <br />PHONE <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air syslems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodslave <br />OWer <br />CITf OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify thai I have read and examined ihis application and know the same to be true and correcL All provisions of laws and <br />ordinaces governing lhis lype of work will be complied with whelher speci(ied herein or not. The granling of a per�nit does not presume <br />to gi� e aulhority to violale or cancel the provision o( any other state or local law rec�ulating conslruction or lhe performance of <br />con: truction. That I am aulhorized by the owner of this property to pedorm the work for which application is made and I comply wilh the <br />Statc Conlractors k.aw ]8:27?26W and 296.200 WAC. <br />. �,�.- . / ,/ -y� <br />F _ � ' � � _�_— /1:i LY.C2C/ .TY� fL �('iC7 � <br />