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SITE ADDRESS <br />;�; v <br />L?GA LOT NO. <br />OESC. <br />� WNER <br />�iSL C- <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE p <br />_ ! <br />�ERMIT APPLICATIUN <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 RRE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK TRACT <br />��� <br />Uvs�zi <br />USE OF BUII.DING <br />S�� <br />WORK DESCRIPTION <br />����, <br />NO. I TYPE OF FIXTURE UP. ITEM <br />Toilet <br />Ba1hWb <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Walnr healer <br />Sink (service/badmop/elc.) <br />BacM(low prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />PARCEL TAX I.D. # <br />ADDRESS <br />FOR <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />�PERMIT N <br />� �� ��-- <br />CITY2IP PI �NE <br />yz� �3� �'9�.3 <br />'"✓er� fl 415 ; �(S� S).�(� <br />PHONE <br />CITYIZIP PHONE <br />I CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />� NC — 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 />Exhausl (2n <br />Heat pump <br />Unil healer <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby corilify lhat I have read and examined this application and know the same to be true and wrzecL NII provisions of laws and <br />ordinaces governing this lype o( work will be con:plied with whether specifed herein or not. The granling o( a permil does not presume <br />to c�ive authoriry to violate or canr,el the provision o( any other slale or local law regulating construclion or Ihe pertormance of <br />con�iruction. Thal I am aulhorized by the owner of this property to peAorm the work for which application is made and I comply with the <br />Stale Contreclors Law 18.27 RCW and 296200 WAC. <br />Signature o( OwnedContractor/Authonzed Agent Date �� L <br />