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SITE ADDRESS <br />/ '- /�, <br />LEGA LOTNO. <br />DESC. <br />TENANYNAME <br />CONTR. LICENSE # <br />PERMIT APPLICATION <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 />/� <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />BLOCK <br />PARCEL TAX I.D. k <br />TRACT OR SUBDIVISION # <br />� ceS /g,� sl - <br />� CONTACT FOR PERMIT <br />!l Y�a !�l✓c« 6�,g �/u�yC, <br />USE OF BUILDING <br />/�S/`�lh�',2 <br />WORK DESCRIPTION <br />0 <br />� i3oz�-Y'��}„e W• 5 <br />I hIEATSOURCE <br />�e.x � �s��r5 <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Oathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Dackllow preveMer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />_ Electric � Gas _ Other <br />y �s �%r <br />NO. <br />PERMIT # <br />M1011—Ul�j <br />CITYIZIP PHONE yp(—S .��� <br />� �. s�.�,-. � s,3� <br />PHONE <br />E-MAIL <br />P <br />'fzl-33B-Syy9 <br />�zio <br />i, ' <br />qrd w 5� <br />CONTRAC7' pRICE OF WORK <br />TYPE OF FIJ(TURE OR ITEM <br />A/C — air handling units <br />�orced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />8oiler <br />Refrigeralion <br />Woodsrove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby certi(y Ihat I have read and examined Ihis applicalion and know the same lo be lrue and correct. All provisions of laws and <br />ordinances goveming this type of work will be complied with whelher speci�ied herein or noL The granting of a permit does not presume <br />to give authority to violale or cancel the provision of any olher stale or loral law regulating consWction or Ihe periormance of <br />consuuclion. That I am authorized by the owner of lhis property to pe�iorm tha work for which application is made and I comply with the <br />State Contr�ctors Law 1�27 fj,CW and 296.200 WAC. <br />