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PERMIT 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 A�CEPTED FROM B AM TO 4 PM <br />SITE ADDRESS <br />��Z� /�%552�,( � <br />LEGAL LOT NO. BLOCK <br />���he.11 �'yo�J��f� <br />TENANTNAME <br />CONTR. LICENSE N <br />USE OF BUILDING <br />pARCEL TAX I.D. # <br />TRACT OR SUBDIVISION N <br />/7820 3l�` <br />ICONTACT FOR PERMIT <br />j'1'�,i C'-�'I <br />WORKDESCRIPTION CE,`�5���'}"G��IOYI <br />d�``,1�x ��:�c� ��cided <br />(�ccL uvtif� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kilchon sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Waler healer <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />HEATSOURCE <br />� Eleclric _ Gas _ Other <br />PMONE <br />PERMIT � <br />98oi� <br />��s�� <br />CONTRACT PRICE OF WORK <br />�� ��ns�c�f-c►� pro�er-�f-t� t�l��t � <br />��il'��c�`�- '�C�b�-. <br />� <br />TYPE OF FO(TURE OR ITEM <br />PJC — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range haod <br />Exdiausl (an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby ceritify that I hava read and e::amined lhis application and know the same to be true and correct. All provisbns of laws and <br />ordinaces governing ihis type o( work will be complied with whether specified herein or not. The granling ot a permit does not presume <br />lo give aulhoriry to violate or cancel the provision o( any other state or Iocal law regulating construction or lhe pedortnance of <br />conslruclion. Thal I am aulhorized by the owner of this property lo peAorm lhe work for which applicalion is made and I comply with lhe <br />State Conlraclors Law 18.27 RCW and 296.200 WAC. <br />���� (�� <br />� � ,-„ ...�`/%'�'�", /I�1(�� Sl-.5 -0�5 <br />