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SITE ADDRESS , <br />��ai �=� <br />LEGA LOTNO. <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />/ /c�M -Z <br />WORK DESCRIPT�ON <br />PtrRMIT APPLICATIGN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />S�- <br />BLOCK TRACT <br />NO. I 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 heater <br />Sink (service/bar/mop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Roof drains <br />Olher <br />ADDRESS <br />HEATSOURCE <br />_ Electric � Gas _ Other <br />.� <br />s g'-0% <br />PERMIT # <br />MalUS-Ol5 <br />33 <br />CITY2IP PHONE <br />CONTRACT PRICE OF WOKIc <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C;1air handiing unils <br />Forced air systems <br />Gas plping <br />Water heater <br />Gas flreplace <br />Gas range <br />Clolhes dryer <br />Rango hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeratlon <br />Woodslo <br />ome� G O��L� <br />CITY OF EVERETT LOCAL SAL[S TAX CODI: IS 3105 <br />I hereby ceritify thal I have read and examined this appli :ation and know lhe same to be true and cortect. All provislons of laws and <br />ordinaces governing this lype of work will be complied with whether specified herein or not. The granling of a pertnit does not presume <br />to give authority to violate or cancel the provision ot any olher state or bcal law regulating consWctlon or lhe performance of <br />construction. T�hat I am aythorized by the owner ot this property lo perform the work for which application is made and I comply with the <br />State Contractors Lav�i18,27�2CW and 296.200 WAC. <br />� . i / <br />