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SITE ADDRES/S/ <br />�5�7_ <br />LEGAL LOT NO. <br />i��/;.�Y�1 <br />TENANTNAME <br />CONTRACTOR <br />PE�.MIT APPLICATIOh <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 <br />PARCEL TAX I.D. # <br />BLOCK � TRACT <br />I CONTACT F012 PERMIT <br />I <br />CONTR. LICENSE # <br />� �� r <br />��-f_�"'i��, /{lu-�7` <br />USE OF BUILDING iT I <br />WORK DESCRIPTION <br />� ��Z�+�i�J� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Dalhlub <br />Lavatory (wash basin) <br />Shawer <br />Kdchen sink 8 disposal <br />Dishwasher <br />Cl�lhes washer <br />Laundry tray <br />Sink (service/badmop/etc.) <br />Bac4.flow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Gre:ase hap <br />Ronf drains <br />Olhcr <br />ADDR[SS <br />HEATSOURCE <br />_ Eleclric _ Gas <br />PERMIT # <br />P,,o��c -c <br />PHONE <br />CIN/ZIP PHONE <br />CONTRACT PRICE OF WORK <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhausl (an <br />Heal pump <br />Unil hea�er <br />Boi!er <br />Re(rigeralion <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti�y that I have read and examined this ap,ilic2tion and know Ihe same to be lrue and correct. All provisions of la,vs and <br />ordin2ces yoverning this type of worA will bo complied wilh whether specified herein or not The granting o( a permit does not presume <br />to g��e aufhority t� violate or cancel Ihe provision of any other stale or local law regulalin9 construclion or the peAormance of <br />construction. Thal i am authorized by the owner of Ihis properly to peAorm the work for which application is ma�e and I comply with lhe <br />Stale Contraclors Law 18.27 RC4V and �96.200 WAC. <br />