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P�RMIT APPLICATI�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDP.R STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FRJM 8 AM TO 4 PM <br />SITE ADDRESB /� � � � <br />%� ° i f%/1 J��%`�' S i, �rs d i� <br />LEGA LOTNO. BLOCK <br />DESC. <br />PARCEL TAX I.D, p <br />1 -�-5/� � Z3�-�-- �o <br />TRACT <br />:�.��;ri.- 3S�S /,�`/'���pL Sz <br />TENANTNAME <br />��ck/� <br />COD(TRACTOR j ,m 1 C�'�1S <br />1 `' <br />��1 CONTR. LICENSE p t� <br />� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />CONTACTFORPERMIT <br />� �l <br />b'— 9—v� <br />. <br />�t�rnvnc � <br />— �J'�'—.�' <br />PHONE <br />AOURESS � � . r CITY2IP PHONE <br />. . /�`�� �� D�a�p, c �r�u��1- � <br />HEAT <br />Eleclric Gas Olher <br />ONTRA�T PRICE OF 1 <br />��� OCt, .� <br />I�?1 �` �c � � ����-��, s�I- �,,.� �� �,(�� I K 1tii C'�o <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Waler heatc;r <br />Sink (service/bar/mop/elc.) <br />Backllow preventer <br />Urinel <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air syslems <br />Gas piping <br />W aler heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby ceriti(y that I have r�ad and examined this application and know the same to be lrue and correct. All provisions of laws and <br />ordinaces governing tiiis type o( work will be complied wilh whether specif ed herein or nol. The granting of a permit does nol presume <br />to give authoriry to violale or cancel lhe provision of any other state or local law regulaling construction or the pedortnance of <br />construction. That I am aulhorized by the owner of this property t� periorm lhe work for whir,h applicaiion is made and I comply wilh the <br />State Contractors aw 16.27 RCW and 296.200 WAC. <br />/fo� �-�- �--- —� �'�'0%��OG <br />