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SITE qDDR�S <br />L7 i <br />LEGAL LOT NO. <br />DESC. <br />L/ / � <br />TENANTNAME <br />; <br />PERMIT APPLlCATIUN <br />clTY 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 />����ti <br />BLOCK <br />�/S <br />PARCEL TAX I.D. # <br />TRACT <br />/ iJ S� <br />CONTACT FOR PERMIT <br />CONTRACTOR A�DRESS <br />D/�rJES JC.e �l(LC :f�•CI.�H/i/�tJG <br />CONTR. LICENSE # �z,� � � <� <br />�.o.ii-<t /�i/lT:7 !/ <br />USE OF BUILDING <br />WORK DESCRIPTION <br />1� � �,ti `r` `� I rJ J <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />_L BathWb <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Z Clolhes washcr <br />L Walcr heater <br />Sink (service/badmop/elc.) <br />Backllow preventer <br />Urinal <br />Drinkinc� ! �ountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Olher <br />Zo/ c/vs-3�3 /l3� <br />PHONE <br />CITY2IP <br />f-cr�'���/ ; gs3� <br />HEATSOURCE <br />Elec�ric Gas Olher <br />PHONE <br />y�� 3s� <br />6 0 i `� <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air h2ndling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heal pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerili(y lhal I have read and examined Ihis applicalion and know ihe same to be lrue and correct. All provisions of laws and <br />ordinaces governiny Ihis lype of work will be complied with �vhelher specified herein or not. The gr2nling of a permit does nol presume <br />to give authority to violate or c2ncel the provision uf any olher stale or local law regulating construction or the performance of <br />conslruclion. That I am authorized by lhe owner of this property lo peAorm the work for which application is made and I comply wilh lhe <br />State Contraclors Law 18.27 RCW and 296200 WAC. <br />Z.—�3-J <br />