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SITE A� � RE55 <br />7, n �zw <br />LEG.4 LOT N0. <br />DESC. <br />OWNER <br />�n!(; N Q <br />TENANTNA E <br />P' :RMIT APPLICATI� �I <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 TO 4 PM <br />� iz <br />BLOCK <br />�4UG{C Ccyi <br />CONTR. LICFNSE # <br />P�.LC NC' <br />USE OF BUILDING <br />r� <br />WORK DESCRIPTION <br />'Z.eL oca rs�C�, Cj, es �.n2r-e�Z <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Pountain <br />Floor drain <br />_ Grease trap <br />Roof drains <br />Other <br />PARCEL TAX I.D. p <br />TRACT OR SUBOIVISION # <br />CONTACT FOR PERMIT <br />HEATSOURCE <br />PHONE <br />��_ � � —!L� <br />PERMIT # <br />r1 i oU�-1 - G� 1 <br />iONE <br />1 3va- -�va <br />E-MAIL <br />CIT�/Z�I� P NE <br />v a5 <br />. 1L=,zK�,.�u ti�A zs3) �8�s <br />Eleclric Gas Other <br />CONTRACT PRICE OF WORK <br />6cx� <br />NO. I NPE OF FI%TURE OR ITEM <br />A/C – air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas renge <br />Clolhes dryer <br />Range hood <br />Exhausl fan <br />Heal pump <br />Uni� healer <br />— eoiler <br />Refrigeralion <br />Woodstove <br />� Olher ��Tc ��.�s <br />n'+ c / eti <br />CIN OF EVERETT LOCAL SALES TA%CODE IS J105 <br />I hereby certify Ihat I have read and examined this applicalion and know lhe same to 6e Irue and wrrect. All provisions of laws and <br />ordinances governing Ihis type of work will be complied with whether specified herein or noL The granting of a permit does not presume <br />lo give aulhoriry lo violate or cancel lhe provision of any other stale or Iocal law regulating construclion or Ihe perfermance of <br />conslruction. Thal I am aulhorized by �he owner of �his property lo perform ihe work for which applicalion is made and I comply wilh lhe <br />State Coniraf�ors Law 18�27 RCW an� 96.200 WAC. <br />.;z .'� :1 �.u.�� y//.1 /�) <br />