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SITE ADDRESS <br />%�� �`i / D % <br />LEGAL LOT NO. <br />� <br />CG t <br />CONTR. LICENSE # <br />USE OFBUILDING <br />� J / � <br />WORK DESCRIPTION <br />NERIIl�IT APPLICATIc�N <br />CITY OF EVERETT PERh�IT SERVICES <br />3200 CEDAR STREET, CVERETT, WA 982G1 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />y� PARCEL TAX I.D. # <br />N....oi,-,�.. -- <br />BLOCK � TRACT OR SUBOIVISION # <br />ICONTACT FOIQ PERMIT <br />I 3f.��2 �a�•�y �e <br />,—L � e AD� � � � � `6''� <br />HEAT SOURCE <br />Electric __ Gas _ Other <br />G�P�a�a /i f o� � f��' -- <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhlub <br />Lavatory (wash basin) <br />Sliower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Waler heater <br />Sink (servicelbar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Rocf drains <br />Olher _ <br />U <br />�' - v2-O�' <br />PERMIT# <br />lI ���:. `0 � _. <br />i5%�,f <br />03 �J ?'/i/ <br />P� �� �sy- ��7�7 <br />G y/:�G/�/��/ y�S7sy <br />✓U' ! !/O�vJ l�. .�, <br />CONTRACT PRICE OF WORK <br />�%` p 7t5 0 . " --- <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gasrange <br />C�olhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />I hereby cerilify lhat I have read and exarnined this application and know lh� same to be Irue and cerrect. All provisions ot laws and <br />ordinaces governing lhis lype of work will be complied with whelher specified herein or noL The grantiny ot a permit does nol presume '. <br />to give �aulhority lo violale or cancel lhe provision of any olher stale or local law regulating construclion or lhe performance of � <br />consiruction. That I am aulhorized by the owner of Chis property to perform the work for which application is made and I comply with the 'I <br />State C���cters Law �18 7 RC/W'and 296.200 WAC. -/ <br />. A'/� 1i��/"�c..�-�— � .2.3-6X I� <br />/ <br />