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SITE ADDRESS <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />TENANT NAME <br />T//d ' D <br />Ry/� T, <br />CONTR. LICENSE 17 /�� <br />USE OF BUILDING <br />WORK OESCRIPTION <br />�� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEREiT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPIICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />.� <br />iLOCK TRACT OR SUBDIVISION # <br />ADDRESS <br />CONTACT FOR PERMIT <br />va�s N�anA-- <br />s�i�c-��s o— <br />y po �ox �s�l <br />'y�g�v <br />I — HEATSOURCE <br />Electric Gas Other <br />�-7/,,�~e S/��"��'r �O%�% <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heafer <br />Sink (service/badmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />�rease Irap <br />Roof drains <br />Other <br />�'�f�'� Y�/ <br />PHONE,u� <br />T�w� l� �'sr <br />'¢/ <br />PRICE OF WORK <br />NO. � TYPE OF FI%TURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrigeration <br />Woodstove <br />OtherT <br />�R7� ��hL.G�C� �� /7 <br />i ' <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />S� <br />1 hereby certify Iliat I have read and ex; �nined this application and know the same to be true and correct. All provisions of laws and <br />ordinances governing this lype oiwork will be complied vaith whether specified herein or not. The granting of a permit does not presume <br />to give aulhority to violate or cancel the provision of any other slate or local law regulating construction or lhe perfortnance ot <br />consiruction. That I am authorized by ihe owner of lhis property lo peRorm ihe work for which application is made and I compiy with the <br />Sta(e C9n¢aclors Law 18.2yR�W and 296200 WAC. <br />� <br />�a <br />