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SITE AODRESS <br />LOT N0. <br />TENANTNAME <br />PE�CMIT 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 M oc� � a- 0 32 <br />TRACT <br />PARCEL TAX I.D. # <br />FOR <br />PERMIT <br />PHONE <br />5�.wi e_ � Ste� � ����'-� �t�5 =5-ok-6s`/7 — <br />,�"C TRACTOR ( ADORESS CITY2IP PHONE <br />vr_-�r-,���s���- ��-�r�+� j�oT �re��t ��c N35=5'o5=6S/7 <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />VJaler heater <br />Sink (servicelbar/mop/etcJ <br />Backflow preventer <br />Urinal <br />Drinking Fountaln <br />Floor drain <br />Grease trap <br />Root drains <br />Other <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Eleclric �Gas _ Olher �9�J� � n <br />P,/'�'rd/Je..� P�,l'f�ffµ.� %�iCsrAc✓t�C <br />MECHANICAL <br />NO. � TYPE OF FUCTURE OR ITEM <br />A�'C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX COOE �S 3105 <br />1 hereby ceritify ihat I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces c�overning this type of work will be complied wilh whether specified horein or nol. The granling of a permit does not presume <br />to give authorily to violale or cancel the provision of any other slale or local law regulaling construclion or the perfortnance of <br />construction. Thal I am authorized by lhe owner of this property to perfomi lhe work for which applicalion is made and I comply with !he <br />SlatQ Contraclors Law 18,27 RCW and 296.200 WAC. <br />