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SI7E ADDRESS <br />LOT NO. <br />� <br />PERMIT A��PLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERET7, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. p <br />3�,�11�3[� <br />BLOCK I TRACT OR SUBDIVISION R <br />—a'� �� <br />PERMIT # <br />n I I �Z -03 � <br />TENANT NAME I CONTACT FOR PERMIT PHONE <br />E-MAIL <br />��— DR S � P <br />�%GS��,�n�-}o�, ��.�urc.� �.aS aG�s w.�c,.i,`�0���1�G q��.o�� �I�.S-'3���-141�� <br />CONT . UCENSE M � P s Nz �1 G-1 `� � J <br />USE OF BUILDING I HEAT SOURCE I CONTRACT�PRIC�E OF WORK <br />Eledric �Gas_Other <br />WORK DESCRIPTION <br />�� �- C� 5h� �� p �,r✓w� 4- <br />u <br />� <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />8athtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking �ountain <br />Floor drain <br />Grease irap <br />Rooi drains <br />Olhe� <br />� <br />NO. I TYPE OF FU(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 />Clothes dryer <br />Range hood <br />Exhaust fan <br />lieat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined lhis application and know Ihe same to be true and correct. All provisions of laws and <br />ordinances governing this type of work will be complied with whether specified h,arein or not. The granGng o( a pertnit does not presume <br />to give authority to vidate or cancel the provision of any other state or local law regulaling conslruction or ihe pedortnance of <br />consiruclion. That I am authorized by thr. owner of this property to pertorm the work for which application is made and I comply wilh the <br />Stale CoNractors La 18.27 RCW and Z9�.200 Wl1C. <br />1%!,� 1; ���, C�I�,' U7,f�- �/�� i � 1 <br />