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c� <br />�� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-Sd10 — FAX 425•257-8857 — www.evereriwa.org <br />2�� Z APPLICATIONS ARE ACCEPTED FROM B MI TO 4 PNI 5�-ay .�, � <br />SITE A�DRESS . I PARCEL TAX I.D. R I PERYR! <br />LEGA LOTNO. <br />DESC. <br />OWNER <br />�. o� SU�v(r <br />TENANTNAME <br />,��' �r ev�r,�' <br />�o�. u��es�l` <br />e. <br />USE OF BUILDING <br />V� � <br />BLOCK TRACTOR <br />"P-�"'�/ <br />WORK DESCRIP710N <br />SIL N��a�i�;ti� <br />NO. � TYPE OF FlXTURE OR ITEM <br />Toilet <br />Bathtub <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 />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Irap <br />Roof drains <br />Other <br />.i G m t' <br />COHTACT FOR PERMIT <br />Le,; LNwi� <br />t <br />�l <br />HEATSOURCE <br />_ Eleciric _ Gas _ Other <br />J'IZ <br />L�✓c'rt� �� <br />�zs'.3y3.5`3y 2 <br />', �✓P+'t' /� `7,8105 <br />ICOyNTRACT PRICE OF WORK <br />r'1 il !Y, n � <br />NO. I TYPE OF FlIRUNE OR ITEM <br />A/C - air handling unils <br />Forced air systems <br />Gas piping <br />Water heafer <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritity Ihat I have read and examined this application and know the same to be true and correct. All provisions o1 laws and <br />ordinaces governing this type of work will be complied with whether specilied herein or not. The granting of a permit dces nol presume <br />to give authority to violate or cancel the provision oi any other state or local law regulating construction or the perfortnance of <br />construction. That I am authorized by Ihe owner of this property to perform the work for which appGcation is made and I comply with the <br />State Contractor Laj�.1� RCW an� 9 200 WAC. <br />�/�� i <br />i'�!��G�l \ 9/. ; 1n 1 i` ti lZ 2 Q� <br />f /L <br />