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SITE ADDRESS <br />or N <br />LEGAL LOT NO. <br />TENANTNAME <br />LICENSE N <br />USE OF BUILDING <br />P�tRMIT APPLICA.TI�,�V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. N <br />BLOCK TRACT OR SUBDIVISION A <br />CONTACT FOR PERMIT <br />aN �/E"FF <br />PERMIT M <br />f/prl�a �63JD <br />e.Ma� <br />'Z <br />HEAT SQURCE CONTRAC7 PRlce or wunn <br />_ Eleciric 1 Gas _ Olher 90� � <br />WORK DESCRIPTION <br />.Q��/�,� ��o�� E;r�ST/.�G ,eE-.si/JE-�l. E- <br />PLUMBING � MECHANICAL <br />NO. I TYPE OF FD(TURE OR ITEM <br />Toilel <br />Balhlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbar/mopletc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <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 />Refrigeration <br />Woodstove <br />Olher — <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriG(y that I have read and examined this applicalion and know the same to be true and crorrect. All provisbns of laws and <br />ordinaces governing this type of work will be complied with whelher speci(ied herein or nat. The granting of a permit does not presume <br />to give authority to violate or cancel the provision ot any other stale or local law regulatlng construcUon or the performance of <br />conslru on. That I am authorized by the owner oi lhis propeAy to peAorm the work for which application is made and I comply with lhe <br />State Co sk�w 18•27 RCW and 296.200 WAC. <br />/ % �-d� <br />