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SITE ADDRESS <br />LEGA LOTNO,^� <br />oesa �� <br />OWNER <br />�k'6�'t/�r/ <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BU�LDING <br />PERMIT APPLICATICjN <br />CITY OF EVERETT PERMIT �ERYICES <br />3200 CEDAR STREET, EVERETT, WA 96201 <br />425-757-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� <br />BLOCN <br />�(/...) ��' . � <br />WORK DESCRIPTION C r ` � <br />J <br />NO. � TYPE OF FI%TURE OR ITEM <br />Toilet ✓ <br />Balhtub � <br />Lavalory (wash basin) � <br />Shower ✓ <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Waler heater <br />Sink (service/bar/mopietc.) <br />Backllow preventer <br />Urinal <br />Orinking Fountain <br />Floor drain <br />Grease trap <br />Roold�airrs---- -- <br />Other <br />PARCEL TAX t.0. N <br />oDkstoaoor.o <br />�/6 vl <br />ITAC�T FOR PERMIT <br />'�.,_. _,.'�S� <br />ADDRESS <br />HEATSOURCE <br />PERMIT �/� <br />�9a0 C�OX -DO <br />�i v / <br />CITY2IP PHONE <br />� ►l s� yZs 9Z� ; <br />PHONE <br />Y�� 3 �/ 3 "y yS'/ <br />CITY2IP PHONE <br />_ Eleclric �f",as _ Olher <br />zZ�� <br />NO. <br />ONTRACT PRICE OF WORK <br />S�`i O � <br />TYPE OF FIXTURE OR ITEM <br />AIC - air handling unils <br />Forced air syslems <br />Gas piping <br />W ater heater <br />Gas fireplace - <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unii heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby cerilify Ihat I have read and examined this application and know the same to be true and corcect. All proviaions of laws and <br />ordinaces governing lhis lype of wqck will be complied wilh whether specified herein or noL The granling o( a pertnil does not presume <br />to give authonty to violate or ca I the provision of any other state or local law regutating consWction or the perfortnance ot <br />construction. That I�� thor' d b � owner of this property to pedorm the work for which application is made and I comply with the <br />Slate ConlractpR tkWX8.2 C and 29G.200 WAC. <br />C� <br />