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SITE ADDRESS _ <br />:y <br />LEGAL LOTNO. <br />C `j <br />TENANT NAME <br />� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, 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. M <br />�� 5 � <br />BLOCK TRACT OR SUBDIVISION i! <br />�"2 / /��� <br />CONTACT FOR PERMR <br />l•VIVIKHI.IVK <br />�ltvF� �f,�v��� r��,����,ub- <br />CONTR. LICENSE # <br />��i� �/F= S S�/65 � i3 <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilcl <br />BalhWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Clolhes washer <br />Waler heater <br />Sink (servicelbadmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Greaso trap <br />Roof drains <br />Olher <br />TN <br />Q( - Do <br />-i�z <br />PHONE <br />E-MAIL <br />S�E�� -Z:1TP71 <br />�Gs� ,�t�J � `iz�- 3j � <br />9�d 3 � � �� � -- <br />HEATSOURCE <br />Electric Gas Olher <br />CONTRACT PRICE OF WORK <br />NO. � TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Waler healer <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Ranc�e hood <br />Exhaustfan <br />Heat pump <br />Unit healer <br />Boiler <br />Refrige�alion <br />Woodstove <br />CITY OP EVERETT LOCAL SALES TAX CODE IS J705 <br />I hereby ceriti(y that I have read and examined lhis applicalion and know the same to be We and cortecL All provisions uf laws and <br />ordinaces governing this type of work will be complied wilh whether specified herein or not. The granling of a permit does not presume <br />lo give aulhority lo violate or cancel lho provision of any other state or locai law regulating construction or lhe peRonnance of <br />conslruction. Thal I am aulhorized by the owner of lhis property lo peAorm lhe work tor which applicalion is made and I comply wilh the <br />Stale CoMrac�ors Law 18.27 RCW and 296200 WAC. <br />�° .�°��� ����� /- b - o r <br />