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SITE ADDRESS� � <br />.�� <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />Gf�/��Tf�O<fi. <br />TENANT NAME <br />�f�/�E <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICE� <br />3200 CEDAR STREET, EVERETT,INA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �`- 9�-� Z <br />�o� vs� <br />BLOCK <br />pl,RCEL TAX I.D. # PERMIT # <br />l-�,�,�_ nvv - D a <� �ZI <br />TRACT OR SUBDIVISION � <br />� 3r�� ��r�y�v�- <br />CONTACT FOR PERMIT <br />o,�✓ �/cFF� <br />CONI KA�. I vrt <br />�v�,��r � �'� ����' a�r--���E• � � <br />CONTR. LICENSE # <br />USE OF BUILDING <br />5�,� <br />����G3. <br />PHONE � <br />��.T.�l�a�. 6 .• �'/ (5 <br />HEAT S RCE GOfV I KHI.I rnn.o vr rrvnn <br />-- — ����,� ri'� <br />Electric _ Gas Other <br />WORK DESCRIPTION <br />/ ��//'��/`D�/�� �.�/.�/%/�� ��`r/%�E-i��'� <br />NO. I TYPE OF FIXTUftE OR ITEM <br />I — <br />Toiiet <br />Bathtub <br />Lavatory (Wash basin) <br />Shower <br />Kltchen sink & disposal <br />Dishwzsher <br />Clothes washer <br />�Nater heater <br />Sink (service/barlmop/etc.) <br />Back9ow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Ulher <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air sysiems <br />% Gas piping <br />�— Water heater <br />Gas f repiace <br />Gasrange <br />-T Clolhes dryer <br />� Range hood <br />i Exhaust fan <br />Heatpump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify Ihat I have read and examined this application and know the same to be tru= and correct. All provisions of laws and <br />ordinances governing this type of work will be complied wilh wheiher specified herein or noL The granting ot a permit does not presume <br />to give aulhority to violate or cancel the provision of any olher slate or local law regulating construclion or the performance oi <br />conslruction. That I am authorized by the owner of this property to perform the work for v+hich application is made ar,d I comply with the <br />State C�ra ors�w 1827 RCW and 296.200 WAC. .� <br />/ _ a� �% <br />