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SiTE ADDRESS <br />LOT NO. � <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8657 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK I TRACT <br />a� 0-03 <br />PARCEL TAX I.D. k <br />oosos�nooao s <br />Ov �, <br />Sdeve., (,orsd IOo9 uar�r�-� E✓a��4$Lo3 �"-'FVg-3'419 <br />TENANTNAME I CONTA�fFORPERMIT PHONE <br />CONTRACTOR <br />CONTR. LICENSE M �%,�a.i/ �.� <br />USE OF BUILDING <br />6araye <br />WQRK DESCRIPTION <br />notp�, {�e.fWIG <br />ADDRESS <br />L�Nir�cie•r <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bath�ub <br />Lavatory (wash basin) <br />Showor <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mopfetc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEATSOURCE <br />_Electric �Gas_Olher <br />NO. <br />CfTV21P PHONE <br />CONTRACT PRICE OP WORK <br />a �;11 <br />��, �I�'� � <br />MECHANICAL <br />TYPE OF FU(TURE OR ITEM <br />A/C — air handling units <br />Forced air sys�ems <br />Gas piping <br />Water heater <br />Gas freplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil heater <br />Boiler <br />Retrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br />I hereby centify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this rype of work will be complied with whether specifed herein or not. The granting o( a permit does not presume <br />to give authority to violate or cancel the provision of any olher state or Iocai law regulating construction or the performance o( <br />construction. That I am authorized by the owner o( this property to nerfortn the work (or which application is made and I comply with the <br />State Contractors Lav,� 1827 RCW and 296.200 WAC. <br />�_/ ¢/Z.� /� b <br />f OwnedCon�r/Authorized Agent Date �/ <br />Z <br />