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SITE ADDRE$g <br />�� ��: <br />LEGAL LOT N0. <br />TENANT <br />l.�l `K�Al;1�UK �� ( <br />.� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />( <br />PEr2MIT 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. p <br />� ve5� cy� <br />BLOCK TRACT OR SUBDIVISION il <br />ADDRE55 <br />� O �� 'Y � rifa t��1'(S� 1'1l) L' <br />CONTACT FOR PERMIT <br />S�0 L, 111a�n �;�- <br />I — HEATSOURCE <br />Electric � Gas Other <br />PNONE <br />�1,onroe � `t �F�a �a <br />CONTRACT PRICE OF WORK <br />WORK DESCRIPTION V <br />�rs�u��a�:or c, S- Gov+nP�e.�e G-<<s �1e�.��v�� S��S�-evv.. <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Backllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greaso trap <br />Roof drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />� Forced air systems <br />� Gas piping <br />Waler heater <br />Gas (ireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this applicalion and kno�v lhe same to be true and correct. Ail provisions of laws and <br />ordinaces governinc� this type of work will be complied with whelher specified herein or noL The granting of a permit does not presume <br />lo c�ive aulhority to violate or cancei the provision of any other stato or local law regulaling consWction or lhe per(ormance o( <br />construclion. That I am aulhorized by �he owner of ihis property to pedorm the work for which application is made and I comply with the <br />Stale Coniraclor�. ur RCW and 296.200 WAC. <br />� � � �,—^� ��' �ie 'i� � <br />