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SITE ADDRESS <br />� - -'�L, / '�) <br />//�l� �� <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENS[ # <br />��RMIT ApPLICATIUN <br />CITY OF E�'ERETT PERMIT SERVICES <br />3200 CEDAR STkEET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS Ai2E ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. �7 <br />� � , -- <br />� i�E �� l ,-:� .� tl�Yi <br />I CONTACT FOR PERMIT <br />USE OF BUIL/DING <br />j�/r���� e.'. 1 ��� ; � , � <br />WORK DESCRIPTION <br />/ � - > � � � � � � J <br />NO. <br />ADORESS <br />�� .. '� -�.�; �i� �i r� c-<. <br />LUMBING <br />TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbadmop/elcJ <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />PERMIT # <br />_ rn�c4-�3 �' <br />CITY/ZIP PHONE �y.p;� -,. <br />_- � <br />�f7'c. ��'cL,�y�, l.�'i�� <br />PHONE <br />HEATSOURCE <br />Eleclric Gas Other <br />. � ���: �-�� <br />NO. <br />CINIZIP <br />PHONE <br />CONTRACT PRICE OF WORK <br />�.� , - �c. c C <br />,�� <br />i <br />C-1 � �� r�li <br />TYPE (�F FIXTURE OR ITEM <br />A/C - air handling unils <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust (an <br />Heat pump <br />Unit heater <br />Builer <br />Re(ric�eraGon <br />N/oodstove <br />CITY OF C-VERETT LOCAL SALES TAX CO�E IS ?105 <br />I hereby ceritify that I have read and examined th�s application and know lhe same lo �e lrue and correcL All provisions of laws and <br />ordinaces governing this type o( work will be complied with whelher speci(ied herein or noL ?he granling of a permit does not presume <br />to yive aulhority lo violale or cancel lhe provision of any olher slale or local law rec�ul�ting construction or the performance of <br />consUuclion. That I am authorized 6y the owner o( Ihis property to perform the work for which application is made and I comply with the <br />Slate Contractors Law 18.27 RCW and 296.200 WP.C. <br />�' <br />, - <br />Signature ot OwnedContreclor/AulhoriZed Agent �� , �Date <br />