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SITE ADDRESS <br />LEGAL LOT NO. <br />DESC. <br />�. <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, F`JERETT, WA 98201 <br />425-257-8810 – FAX 425-257-d857 – www.everet;�va.org <br />APPLICATIONS ARE ACCEPTED FROM1'; 8 AM TO 4 PM �` <br />�=1 —i Z <br />PAF:CELTAX I.D. # ERMIT # <br />�o e�r T�.�1�� - GU�- ODO -DOt� � � ��o�� o0 5 <br />BLOCK TRACT OR SUB�IVISION � <br />f/o��sii✓� �°�Ty���r/ <br />TENANT NAME <br />SP/�'� <br />ADDRESS /J CINIZIP PHONE <br />��� ��iLr`� /Ti�� �(�c�� �2_.r :�0.3. /�G/ <br />g,P�o� <br />I� CONTACT FOR PERfAIT <br />�/✓ /��� �. <br />I.UPo I KHI. 1 Jn <br />Fd�/�c�T f��dli//G � �Tf/ar�i i % <br />CONTR. LICENSE �' . <br />USE OF BJILDING <br />. SF,�' <br />WORK DESCRIPTION <br />,�r��l�,��/���i�G�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toiiet <br />Bathtub <br />�avatory (wash basin) <br />Shower ' <br />Kitehe^ sink & disposal <br />Dishwasher . <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Back"��: preventer <br />Uriral <br />Drinking Fountain <br />Floor o: ain <br />Grease trap <br />Root dreins <br />Other <br />c/ZS:UG �39D <br />— HEATSOURCE I Lurvinfu.i rni�.�.�� ,���•�. <br />Electric ��as Other <br />E"�E'is�r�✓G ��s�G�r✓�� <br />Dn��ra�l <br />�v i n.d.� 5 <br />IJO. I TYPE OF FIXTURE OR ITEM <br />H/C — air handling units <br />Forced air systems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gas renge <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeratic^ <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TA`; CODE IS 3105 <br />I hereby cerlify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinances governing this type of �a'ork vaill be complied wil'n whelher specified herein or not. The granting of a permit does nol presume <br />to give authority to violate or cancel the provision of any olher slale or local law rzgulating construclion or the performance of <br />constru ion. That I am authorized by the owner of this property lo perform ihe work for which applicalion is made and I comply wilh the <br />Stat:��ors Laev 1827 RCW and 296.200 WAC. <br />i o� %'_� �7 <br />