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SITE ADDRESS <br />'��vl / <br />LEGAL LOTNO. <br />DESC. <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREEi', EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />. � � �- � <br />BLOCK TRACT OR SUBDIVISION p <br />PERMIT # <br />11�i �7/ � - c�o <br />lC`11,E Out�klAr� �so� NA2�t�s�N Avt Ev�t�l` 9�0� �c� (�S3a <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />`��= - �O �5 � ' �-�i-� b E-MAIL <br />C N A O I IP H NE <br />CONiR. LICENSE p <br />USE OF BUILDING � HEAT SOURCE � CONTRACT PRICE OF WORK <br />_ Eleclric � Gas _ Other <br />WORKUESCRIPTION A��I���L GA� CcNJL��S�� <br />IV <br />D�L�IEr� , s—,��� , � �.�-NAc� <br />NO. I TVPE OF FIXTURE OR ITEM <br />� <br />Toilet <br />Bathlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Oishwasher <br />Clothes washer <br />Waler healer <br />Sink (service/barlmop/elc.) <br />BackOow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas tireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVEREST LOCAL SALES TAl( CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this application and know the same to be lrue and correcL All provisions of laws and <br />ordinaces goveming this rype of work will be complied Hdh whelher specified herein or nol The granting ot a permil does nol presume <br />to give aulhoriry to violale or cancel the provision of am/ olher state or local law regulating construction or the performance o( <br />conslruction;Thal � am authorized by the owner of this property to perform the work tor which application is made and I comply wilh the <br />State Co tr clors L w 1 27 R� W and 296.200 WAC. <br />�— t�-y - a� <br />Signalure ol�w \Con raC or/Authorized Agent Date <br />.1 <br />�1 <br />