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SITE <br />LOT NO. <br />0 <br />TENANTNAM �� <br />CONTRA �OR 7 yY�[Y�.� <br />CONTR. LICENSE N <br />USE OF BUILDING <br />S r /� <br />WORK DESCRIPTION <br />---( - -- <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SER�/ICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br />APPLICATIONS pRE ACCEPTE� FROM 8 AM TO d PM <br />, I PARCEL TA% I.D. N <br />: L.. <br />BLOCK TRACT <br />CCNTACT FOR PERMIT <br />/1 (� � <br />( ��^�. lr.ur�. <br />�,u��f^1� ADDRESS <br />�rs <br />� <br />J . CITYIZ(P <br />��� �> �?N<<� �c <br />�'� �; k <br />HEATSOURCE <br />ElecMc � Gas _ Olher <br />�Y_��4<<� ����, SJ-� ��, �I ��1� <br />No� I TYPE OF FIXTURE OR ITEM <br />—L <br />Toilet <br />Balhtub <br />_ Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Cbthes washer <br />Laundry lray <br />_ Sink (servicelbarlmopletc.) <br />BackOow preventer <br />Urina� <br />Dnnking Fountain <br />Floor drain <br />Grcase trap <br />Roof drains <br />Other <br />�fl �-�le� <br />PF.RMIT X <br />= o� z-��3 <br />PHONE <br />4�-.� `' %o <br />�- _��-. sc <br />PHONE <br />_ i' - c�� <br />PHONE <br />a5s• ��i3•C�c- <br />CONTRACT PRICE CF WORK <br />•'.l. �z �� eo <br />NO. I TyPE OF FIXTURE OR ITEM <br />_ ivc — air nanmirg units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas firaplace <br />_ Gasrange <br />Cbthes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />_ Unit heatnr <br />Boiler <br />Refngeretion <br />_ Woodstovo <br />� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br />I herehy ceritify thal I have read and examined ihis application and know the same ta be lrue and correct. All provisions ol �aws and <br />ordinaces governing Ihis type ol work will be complied wdh whether specified herein or noL The grenling ol a permrt does not presume <br />to give euthonty to violele or cencel the pmviaion of eny other stete or local law reyuleGng conalruclion or Ihe performence o! <br />constmction. That I am authonzed by ihe owner of this pmperty to pertorm the work far which applicaHon is made and I comply vnth the <br />Stale.Contracror Law 1 27 RCW and 296.200 WAC. <br />.i: �'�--�� ,�C � C )�1� � � <br />�- �---�--� � � �� C - �-� <br />'�� <br />