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SITE ADDRESS <br />LOT N0. <br />TENANTNAME <br />CONTRACTOR <br />f�i d �✓'S,'o� � <br />CONTR. LICENSE p <br />USE OF BUILDING <br />�v�/s�- <br />WORK DESCRIPTION <br />f��✓ <br />PtRMIT APPLICATIUN <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 />BLOCK I TRACT <br />�%t%�v1�' G6.c <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backilow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease traU <br />Roof drains <br />Olher <br />PARCEL TA% I.D. A� <br />CONTACT FOR PERMIT <br />ADDRESS <br />�'i/6 S �"`L <br />HEATSOURCE <br />EI�� Gas Other <br />PERMIT �1 <br />,�io � -�N 3 <br />C e// <br />CITY2IP PHONE <br />��/e-:�'�-' lfzS Z5S 4�/!d <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXNRE OR ITEM <br />A/C — air handlinc� unils <br />Forced air syslems <br />Gas piping <br />W ater heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Urif heater <br />Boiler <br />Re(rigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y thal I have read and examined this application and know the same to be lrue and correct. All provisions o( laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or noL The grenting oi a permit does not presume <br />to give authonty to violate or cancel the provision of any other state or local law reaulating consWclion vr Ihe performance of <br />construclion. That I am aWhorized by the owner of Ihis property to perfon:� lhe work for which appiication is made and I comply with lhe <br />Slate CoNraclors �aw 18.27 RCW and 296.200 WAC. <br />Signature of OwnedContraciodAuthorized Agenl Date <br />