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SITE ADDRESS <br />LEGAL , LOT,NO., <br />DESC. <br />� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />F .RMIT APPLICATI� .� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.��rg <br />APPLICATIONS ARE ACCEPTED FkOM 8 AM TO 4 PM <br />BLOCK <br />r ��� --- <br />� <br />� � ��t �_/ <br />F� � ��-''� /1 I I I� '� <br />WORK DESCRIPTIONJ� � <br />� <br />�i�V�I V�— <br />a F y �� f��5 <br />-�� /7� /-J /i 7 <br />NO. I TYPE OF FIXTURE OR ITEM <br />� Toi�et <br />� Bathtub <br />1 Lavatory (wash basin) <br />Shower <br />l Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Wa�or heater <br />Sink (servicelbadmop/elc.) <br />Backflow prevenler <br />Urina� <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />ADDRESS <br />��:�,3-� /L'��� <br />CONTACT FOR PERMIT <br />''��-� S '1���1�� <br />DRE S <br />j'��i/ v�s�������-��� <br />��°ri �� <br />HEAT SOURCE <br />_ Eiectric _ Gas _ Olher <br />�,-o:-�.� <br />s�t� c r! . <br />— G�-C-C' <br />� s-� - <br />�, c <br /># <br />rn nc ��_y/ �/ <br />�,� ;,� � � 'S33 <br />PHONEJ�-�� G��j�—O(Z j <br />�1 <br />E-MAIL <br />'IZI P 0 E <br />�,,-r �l2 S y 8 i-o iz 3 <br />CONTRACT PRICE OF WORK <br />�,� r,-t �7S�Jf�'1� <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling unils <br />Forced air sys�ems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodslove <br />Olher <br />CITY OF EVEREtt LOCAL SALES TAX CODE IS 3105 <br />I h�ereby certify Ihal I have read and examined this application and know lhe same to be irue and correct. All provisions nf laws and <br />ordinances governinc� ihis lype of work will be complied wilh whelher speci�ed herein or nol. The granling ot a parmit does not presume <br />to give authoriry to violale or canr.ei lhe provision o` any other state or local law regulaling consiruction or the peAormance of <br />construclion. That I am aulhorized by the owner of Ih�s property to periorm tha work for which applicalion �s made and I comply with the <br />Stalo Centractors Law 18.27 RCW and 96.200 WAC. <br />�,. _ f� ; -�.-y �� �J/�/% Z�� %0/l� <br />... _=�;,-i � — <br />