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SITE ADDRESS <br />� Co /-�� <br />LEGAL LOT NO. <br />P�RMIT APPLICATIO�� <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 />s�' <br />BLOCK <br />`-� /�" �1 �1 � �. <br />TENANTNAME <br />PARCEL TAX I.D. N <br />TRACT <br />ADURESS <br />� d /�y � <br />CONTACT FOR P MIT <br />CONTRACTOR ����3 S£RV/ L� I�/.,�j°`�DRESS CITYRIP <br />!/� d�`� i'?d�rsa,- <br />CONTR. LICENSE A <br />v.�vc- ssPr�s J-� <br />USE OF BUILDING <br />WORK DESCRIPTION <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Watar heater <br />Sink (sarvice/bar/moplelc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountaln <br />Floor drain <br />Greaso trap <br />Roof drains <br />Other <br />HEATSOURCE <br />Eleclric Gas Other <br />PE TN <br />_� <br />PHONE <br />�;��I53,o 3- /�2 � <br />PHONE <br />PHONE <br />w� <br />L5 = 5 T� - 4� oF' � <br />r,ONTRACT PRICE OF WOR C <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C — afr handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas firoplace <br />Gas renge <br />Clothes dryer <br />Rango hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX LODE IS 7105 <br />I hereby ceritify that I have road and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinacos goveming this rypo of work will be complied with whelher specified herein or nol. The granting of a pertnit does not presume <br />to give authorily to violate or cancel the provision o( any other state or local law regulating construcdon or the pedormance ot <br />construction. That I am authorized by the ownor oi lhis property to periorm Ihe work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 29fi.200 WAC. � <br />