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S/I,TE ADDR/ESS <br />`�5 / `r�C���� <br />LEGAL LOT NO. <br />� <br />P�RMIT APPLICATIGN <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 TU 4 PM <br />BLOCK <br />f/dl/f✓l f!r/%H <br />TENANTNAME <br />��Ar�E <br />PARCEL TAX I.D. # <br />�.S�z- oo - poLs - DoD <br />TRACT OR SUBDIVISION # <br />ADDRESS CITY <br />3/�r 7 C'�CBf/ fld� �l��i <br />ICONTACT FOR PERMIT <br />, .P�ti i��FF <br />G �I b�o� <br />PERMIT # <br />Mb57D(�-DZ7_ <br />3a3. //Z I <br />PHONE <br />�z�s'a�•6390 <br />wnircAc�vn ...... _...._.. -. <br />j/r'.�FTl f/oS�.��G At�TH,cirY 3/�> ��c1.6'y .l dF c�'/� F�� �pZol <br />CONTR. LICENSE # <br />USE OF BUILD�NG <br />SF2 <br />HEAT SOSIRCE <br />_ Electric � Gas _ Olher <br />CONTRACT PRICE OF WORK <br />S��DD, � <br />WORKDESCRIPTION��-������j��� F,r'/s7"/NG ��S�OFNLE' <br />�iTE` T/an/ <br />PLUMBING <br />NO. I NPI: OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (serviceNadmop/etc.) <br />Back(low preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease irap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C – air handlinc� units <br />Forced air syslems <br />�Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />� Clothes dryer <br />%— Rangehood <br />� Exhaust fan <br />Heal pump <br />Unil heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify thal I have read and examined this application and know the same to be Uue and correct. All provisions of laws and <br />ordinaces c�overning this rype of work will be complied with whelher specified herein or not. The granting of a permit does not presume <br />lo give authority lo violate or cancel lhe provision ot any other state or local law regulaling construclion or the performance of <br />construction. Thal I am aulhorized by the owner of this property to pedorm ihe work for which application is made and I comply with the <br />State C�er�t8'ctgca�'iaw 10.27 RCW and 296.200 WAC. <br />