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SITE ADDRESS <br />LOT NO. <br />F-ERMIT APPLICATIvN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 — FAX 425-257-d857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br />�� �'C �—. <br />BLOCK TRACT <br />PARCEL TAX I.D. # <br />- �l0/ , 2�i.�"SL - U o Z <br />S-aa-� <br />trG-e._• � .� SSaGi.B. �P9 <br />TENAr�yAM��_ ���,��p CONTACTFONPERMIT PHONE <br />� .�+�-.r � C9� <br />.��� N �� <br />CONTRACTOR�G���'s'�yy G �'�,s�RESS CITYIZIP PHONE <br />y�r1�Lo.vw .or�rolcs �4 f�/l6�►w �0�9�9 309,, <br />CONTR. LICENSE # h C/��G �)F' D�� �/ ��, �s3 <br />f � � - <br />USE OF BUILD�NG <br />WORK DESCRIPTION <br />HEAT SOURCE I CONTRACT PRICE OF WORK <br />Electric _ Gas _ Olher <br />�""' S `✓.� �j~ �� ^^�— �/i,,.,- b� wa,xs <br />NO. I IYPE OF FIXTURE OR ITEM <br />L 7oilet <br />Balhtub <br />� Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />� Sink (scrvice/badmop/elc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Irap <br />Roof drain�s/ <br />� OUier �I--�+� SMr.E. <br />NO. I TYPE OF FIXiURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas firepiace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustian <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined lhis application and know the same to be true and correcL All provisions of laws and <br />ordinaces governing this type of work wilt be complied wilh whether speci5ed herein or noL The granting of a permit does not presume <br />to give authority lo violale or cancel lhe provision oi any olher stale or local law regulating construction or the performance of <br />conslruclion. That 1 am aulhorized by the owner of this property lo peAorm the work for which applicalion is made and I comply with lhe <br />Sta�e CnNrar.tor.: Law 18.27 RCW and 296200 WAC. <br />