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SITE ADD_ ESS <br />�� �� , <br />LEGAL LOT NO. <br />�o� � <br />NAME <br />, <br />tRMIT APPLiCATI(�N <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 B AM TO 4 PM <br />PARCEL TAX I.D. A <br />cAs°3�� 1�00 <br />TRACT OR SUBDIVISION N <br />>�v��) �l� -��1* <br />a v D QUc� �t- CONTACT FOR PERMIT <br />�� 1��� <br />c�„���-��cn v� <br />�°Cr T ��552-- <br />USE OF BUILDING <br />� <br />�' � <br />� <br />�`a-g—�� <br />MIT M <br />-� I I Y c�2D <br />CITY2IP I rnVnt <br />�'��,r�..il� g�-'�� <br />�� <br />t1��� <br />� ��� <br />r`!� c�41 S , <br />_ Electric Gas _ Other <br />WORK DESCRIPTION n/� / <br />�r�,,w•Q �.�X�C_, , �(7J:/ vz u �% �oo� <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />W ater heater <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Olher <br />PHONE '�j('oO (F�j� <br />r�--.D r x�Z <br />,,�,��i��–�- �} � �—� Z <br />CONTRACT PRICE OF WORK <br />� �u; a�o <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas firepiace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust lan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstovn <br />Other <br />CITY OF EVERETT LOCAL SALES TN( COUE IS 3105 <br />I hereby cerilify thal 1 have read and examined ihis applicalion and know the same lo ba true and correcL All provisions of laws and <br />ordinaces governing lhis type o( work will be complied with whelher specified herein or noL The granting of a pertnit does nol presume <br />lo give authoriry to violale or cancei the provision of any olher slate or local law regula'ing consWclion or lhe peAormance of <br />constru Pn.,, a am authorized by the owner of this property lo peRorm lhe work fo: which application is made and I comply with the <br />Stale dracl�rs L 1fi.27 RCW and 296.200 WAC. <br />� � 27 -� g <br />Signat e o ractodAuthorized Agent Dale `/ <br />� <br />