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7�1�.� <br />SITE ADDRESS <br />� <br />L GA LOT NO. <br />DESC. <br />OWNER <br />TENANTNA E <br />�a �� <br />CONTRACTOR J �/� <br />/%/ ��� <br />CONTR. LICENSE # ,��/� Y <br />USE OF BUILDI G N <br />WORK DESCRIPTION <br />l <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETf, WA 98201 <br />425-257-8810 — FAX 425-257-885? — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />-# G <br />BLOCK TRACT <br />ADDRESS <br />�O ICONTACT FOR P <br />��4 <br />L � ADqRf�SS� <br />,� N u ., <br />���� ` J�/ <br />I HEAT <br />r��y''e �(��%''�i'D.�% <br />/ <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />Bathlub <br />Lavalory (wash basin) <br />Shawer <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Wa1er heater <br />Sink (service/badmop/etc.) <br />Back(low prevenlcr <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Irap <br />Roo( drains <br />Olher _ <br />6 .. � � --a6 <br />PHONE <br />�o�'� .�s3--91� <br />1 ciTvrziP <br />Ti4kio�'l� <br />Electric Gas Olher <br />'l� <br />CONTRACT PRICE OF WORK <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 />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other � <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritity that 1 have read and examined this application and know Ihe same to be true and correct. All provisions of iaws and <br />ordinaces c�oveming this rype of work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancei the provision o( any oiher state or local �aw regulaling construcGon or lhe periormance of <br />construclion. That I am authorized by the owner of this property lo pertorm the work for which application is made and I comply with the <br />Slale Contrac rs Law 1827 RCW and 296.200 WAC. <br />/ t'i/l/s� /q / ��f��'�,���_��� <br />c���n�t� ctor�//i�rn ze Aaen� DalO <br />