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SITE ADDRES5 <br />/03� <br />LEGA LOT NO. <br />(� <br />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 ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. / <br />r- t3L�� (�O a <br />BLOCK TRACT OR SUBDIVISION N <br />000._D�o f''(1tPLE i�ri�•�+� s 17r� �z <br />"/�Jr� K��oTG1' <br />TENANTNAME <br />D �M�� <br />CONTR. LI��� <br />USE OF BUILDING <br />lz�Si�ENCE <br />WORit nESCRIPTION � <br />,�::f� l� �•i;:�� w`:`%f:-r;% <br />03� �h! uK�i <br />� CONTACT FOR PERMIT <br />PERMIT M <br />� <br />GE..a. .7Qti� 3fL �98`� <br />/�or/� 4cs— 3 z z 4�( 8 <br />PHONE <br />— HEAT SOURCE I CONTRACT PRICE OF WORK <br />�lectric �' Gas _ Other <br />�. <br />;�i�7�.-_{ �:1,�-> � <br />N0. I TYPE OF FIXTURE OR ITEM <br />( ✓ Tailel / <br />� � Bathtub / <br />� �/ Lavatory (wash basin) // <br />� Shower <br />� JG Kilchen sink 8 disposal <br />� �/ Dishwasher <br />� � Clolhes washer <br />� Waterhealer <br />� Sink(servicelbarlmop/etc.) �^�� <br />Backtlow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Root drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />Forced air systems <br />Gas piping <br />Waterheater — <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hoed � �� <br />Exhausttan�..� — <br />Heat pump <br />Unit healer <br />Boiler <br />Reirigeretion <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify Ihat I have read and examined this applicaGon and know lhe same to be true and correct. All provisions of laws and <br />ordinaces goveming this type of work will be complied with whelher specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel lhe provision of any other state or local law regulating construction or the perfortnance of <br />construction. That 1 am authorized by the owner of lhis property to perfortn the work for which application is made and I comply wilh the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />`�a <br />