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SITE ADDRESS <br />73�`— <br />LEGAI LOT NO. <br />P��RMIT APPLICATIVN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-E857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTEU FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. M PERMIT N <br />�S'91-oo/-OQGboO (ulU <br />BLOCK I TRACT OR SUBDIVISION p <br />��� <br />�, yzr-3�3 �rz, <br />TENANTNAME CONTACTFORPERMIT PHONE <br />SA/l� �nrv �r/�� ��s ; So�� .� 90 <br />R g I <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEAT SOURCE <br />_ Electric ✓ Gas _ Olher <br />WORK DESCRIPTION <br />,�F/�i�/�',':eF/3/DOE "L t=,r'/sTi.✓G .fFs/��/C� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />F�oor drain <br />Grease trap <br />Roo( drains <br />Other <br />PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR 17EM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas lireplace <br />Gas rango <br />Clolhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby corilify Ihal I have read and examined this applicalion and know lhe same lo be lrue :�nd correcl. All provisions of laws and <br />ordinaces governing Ihis type oi work will be complied with whelher specified herein or not. The granting of a permil does nol presume <br />to c�ive authoriry to violale or cancel the provision of any olher slate or local law ragulating cons�ruction or the peAormance of <br />construc n. That I am aulhorized by the owner of this property to peAorm lhe work for which application is made and I comply wilh lhe <br />Stale Co v 18.27 RCW and 296.200 WAC. <br />� Z-3`�% <br />