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SITE ADDRESS <br />LOT NO. <br />TENANT NAME <br />PERMIT APPLiCATION <br />CIT'Y OF EVERETT f?ERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8657 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />l���Df i�� <br />� BLOCK <br />PARCEL TAX I.D. # <br />i--l>h/- DO D- D Od <br />TRACT OR SUBDIVISION # <br />V s;� % ��� G <br />CONTACT FOR P[RMIT <br />�O/�/ �✓��` <br />wnirtn�iun <br />�ic:�'�Ti �J�g'/.�C �c�;'11�.�/TJ� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />�/ / ` <br />7 <br />� <br />� - � ; U <br />R T# <br />/7.'7 <br />�/ Y� J .'��03. �r, <br />PHONE � <br />�c'-s�s �'� � % � n <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Eleclric V (ias _ Olher /Q Q �J �. �� <br />WORK DESCRIPTION <br />,��f «/,��f`"%����E"� ��t%STi�I -1��.�1//E`,P/2A%�r�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toile� <br />f3athWb <br />Lavatory (wash basin) <br />Shower <br />Kifchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />4Vater hea�er <br />Sink (service/barhnop/etc.) <br />Dackfav preventer <br />Urinal <br />Drinking Fountain <br />�looi drain <br />Grease irap <br />Roof drains <br />-- Other <br />NO. <br />TYPE OF FIXTURE OR I fEM <br />A/C — air handling units <br />Forced air systeins <br />Gas piping <br />Water healer <br />Gasfreplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exl�ausl lan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigera�ion <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 5105 <br />I hereb�• certi(y �hat I have read and examined ihis application and know lhe same lo be true and correcL All provisions of laws and <br />ordinances governing �his type o( werk will be complied with whether specifed herein or not. The granting of a permit does nol presume <br />to yive authority lo viola�e or cancel the provision of any other s�ale or local law regulating construdion or lhe per(ormance o( <br />construction. 'hal I am authorized hy the owner of this property lo perform ihe work for a�hich application is made and I comply with the <br />State Co�.erB L�w 1P.27 RCVJ and 29G.200 VYAC. <br />i� 6-/0 <br />Date � <br />