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SITE ADDRESS <br />LEGAO� OT NO. <br />DESC. <br />OWNER <br />u�� S�'M <br />TE ANT ME <br />QItO H� N� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 93201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM Q�.17 —�v <br />BLOCN <br />PARCEL TAX I.D. k <br />TRACT OR SUBDIVISION R <br />L�� /69ia <br />CONTACT FOR PERMIT <br />�'Bt�y urn �'oYt <br />l. V I'11 RM�.1 V R ^""••""' <br />��� Su•,a C"o� �o� $ "iC#�cv„'"�eY � <br />CONTR. LICENSE k�R.�-f-�.�q�-� D 1 <br />USE OF BUILDING <br />WORK DESCRIPTION <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />/ Ve� ��S yf �fM� //E� Y'�. <br />/ � <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />� <br />PERMIY M ,` '(-� <br />1� i f`i )�i' — W di <br />PHONE <br />9813lF <br />CONTRACT PRICE OF Wv1iR <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Ezhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify lhal I have read and exami��ed this application and know the same to be Irue and correct. All provisions of lews and <br />ordinances governing ihis type of work will be complied wilh whether specified herein or not. The granting ot a pertnit dces not presume <br />to give authority lo vidate or cancel the provision of any other state or local law regulating conslruction or the perfortnance of <br />cons�ruction. Thal I am authorized by lhe owner of Ihis property to perform the work for which application is made and I comply with Ihe <br />State Contradors Law 18.27 FZCW and 296.� WAC. � <br />� <br />