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f <br />P�RIIlIIT APPLICATIUN <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 />SITE ADDRESS <br />�/i L"/�✓G'�i✓ <br />IEGAL LOT NO. BLOCK <br />C� <br />TENANTNAME <br />PARCEL TAX I.D. # <br />-� .nnv=�noo- <br />TRACT <br />,��-7 ���cyqdF- <br />� CONTACT FOR PERMIT <br />PHONE <br />-a3 <br />sA��� I %,�,��FFF ��� .so� 6�?�0 <br />CONTRACTOR ADDRESS CIIYIZIP PHONE <br />Ev�Err,�,,.r,,�c �t� �rrr��',Ty" <br />CONTR. LICENSE p <br />USE OF BUILDING <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Eleciric V Gas _ Olher 9(,n � <br />WORK DESCRIPTION. <br />,� �,9��//.�e�i'��'c�l f.�i.JTi'��, /1f ,r�o�i�lF" c�— <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink G disposal <br />Dishwasher <br />Clolhes washer <br />Waler healer <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roo( drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />� Gas piping <br />�— Waterhealer <br />_ Gas fireplace <br />Gas range <br />%— Clothes dryer <br />Z Range hood <br />2 Exhaustfan <br />Heatpump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify that I have read and examined lhis application and kr.oe� the saine to be true and correcL All provisions of laws and <br />ordinaces governing Ihis type of work will be complied wilh whelher specified herein or noL The grantin9 of a permil does not r;esume <br />lo give aulhoriiy to violale or cancel the provision of any other slale or local law regulating construction or lhe performance of <br />conslruclion. That I am au�horized by lhe owner of this property lo perform the work for which applicalion is made and I comply wilh the <br />State Co� Law 18.27 RCW and 296.200 WAC. <br />7-�o'�J <br />