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T <br />LOT <br />�71(.YN <br />PERMIT AePPLICATION <br />CITY OF EVERETT PERMIT SERVICES 1 b ��� �� <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-881 U— FAX 425-257-8857 — www.everettwa.or� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�� c <br />•T�� �C, <br />TENANTNAME <br />���f �l�L <br />CON RACTOR �/��� A <br />�< i� <br />CONTR. LICENSE �, A r{�' y�S <br />r� r�� I <br />USE OF BUILDING <br />BLOCK <br />PARCEL TA7( I.D. # <br />fi;7_Cy� <br />CONTACT FOR PERMIT <br />l�oner � ,'u; <br />� Z2/� / GU <br />HEATSOURCE <br />ElecMc Gas Olher <br />PERMIT X <br />>O�/�� — �!/� <br />PHONE (�L(� <br />Z�—�z�—l�Z� <br />CITYIZIP PNONE <br />1�����`�'� �1-� <br />I CONTRACT PRICE OF WORK <br />WORKDESCRIPTION NS f..��/ G(��c/ /c-��r,5� C'Fa �"acc'w�--//(�f/�z.i� s�9�! <br />/ <br />NO. I TYPE OF FI%TURE OR ITEM <br />Toilet <br />BathWb <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry lray <br />Sink (service/bar/mop/e1c. ) <br />Backflow preventer <br />Unnal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FI%TURE OR ITEM <br />FVG — air handiing umts <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas ra�ge <br />Clathe.; dryer <br />Range h�-d <br />Exhaustfa. <br />Heat pump <br />�nit healer <br />Boiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby centi(y that 1 have read and examined this application and know the same to be t�ue and cortect. All provisions of laws and <br />ordinaces governing this type of work vnll be complied with whelher specified herein or noL The granting of a pertnit does not presume <br />lo giv onty to violate or cancel t provision of any other slate or local law regulating wnsW dion or the peRortnance of <br />slruyyy Hon. That I am authori ed t e owner of this propehy to perfortn the wohc for which application is made and I comply wilh the <br />Sta(e,COntnra� rs Law 1/27 R� a 296.200.WAC. �J ��/�/ <br />\ l �(.% )/1�1,t,Cd�1 � 'f �� L.C�/� <br />�(Z <br />