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SITE ADDRESS <br />� 7 G <br />LEGAL LOT NO. <br />DESC. <br />� <br />TENANTNAME <br />CONTR. LICENSE # <br />USE OF BUILDING <br />� <br />PtRMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEGAR STREET, EVERETT, VuA 98201 <br />425-257-8810 — FAX 425-257-8857 — vwvw.everethva.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />v <br />WORK OESCRIPTION <br />!V C VL� 4�V {�' tP � ✓ C T✓ 1 L C <br />Np, � TYPE OF FIXTURE Oft ITEM <br />Toilet <br />6alhWb <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/badmop/etc.) <br />6ackflow pr�venler <br />Urin21 <br />Drinking Founlain <br />Floor drain <br />Grease Irap <br />Roof drains <br />Olher <br />PARCEL TAX I.D. # <br />TFACT OR SUBDIVISION # <br />ICONTACT FOR PERMIT <br />���- '�i�� , <br />HEATSOURGE <br />E�ectric Ga:: Olher <br />PHONE <br />PERMIT p <br />ah-a�y-ayo <br />;-aYy-o�oy <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A�C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas firep�ace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heal pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAl( CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this application and know the same lo be We and correct. All provisions of laws and <br />ordinaces governing this type ot work will be complied wilh w!iether speci(ied herein or not The granling of a permit does nol presume <br />to give authoriry to violale or cancel Ihe provision of any othr.r state or local law regulaling conslruclion or the perfomance of <br />construction. Thal I am authorized by lhe owner of this prot�erty to periorm lho work (or which application is made and i comply with lhe <br />Stale Contractors Law 1827 RCW and 296.200 WAC. <br />� ' /���� �� lla/�� � <br />�'� s� y� � - <br />