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R :RMIT APPLICATI',. N <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 />SITE ADDRESS <br />' 05 N<,ssau S� <br />LEGA LOT NO. BLOCK <br />DESC. <br />OWNER <br />DeM��f" /''vrjc <br />TENANTNAME <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />cf�5 /�SSqu St' E�/erc�% `/PZoI <br />CONTACT FOR PERMIT <br />PHONE <br />�2M���f' /�'lOrJc I E•MA�L <br />p /I <br />CONTR. LICENSE # <br />USE OF BUILDING <br />PERMIT # <br />4Z5 32Z �5�5 <br />— HEAT SOURCE I CONTRACT PKlce or wunn <br />Eleclric _ Gas _ Other <br />WdRK DESCRfPTION / , /' <br />c^5'' �� ^ -.��(//C.S ��.�(�.� <br />/�� i- <br />S i�ee�i r� ��� ,�-s �� � <br />, <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />�(Y�'�iGJir�.� �// "U ��� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />,7 Range hood <br />Exhaust fan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify that I have read and examined this application and know lhe same to be true and correct. All provisions of laws and <br />ordinances governing �his type of work will be complied with whether specified herein or nol. The granting of a permit does nol presume <br />to give authority lo violate or cancel the provision of any other state or tocal law regulating construction or the performance of <br />construction. That 1 am authorized by the owner of Ihis property to perform the work for which applicalion is made and I comply with the <br />State Conlraclors law 18.27 RCW and 296.200 WAC. <br />