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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 ACCEPTED FROM 8 AM TO 4 PM -� ` j�—� <br />SITE ADDRESS <br />ta�-� w. MuK1��0 ��vd. <br />LEGA LOT NO. � BLOCK <br />PARCEL TAX I.D. # <br />TAACT OR SUBDIVISIOP! # <br />�NO�b�ll`� f'UC' 1 SOz 7 5�� 5'f SW �VV�KEfT �8�03 425 -873 — 56 <br />TENANT NAME CONTACT FOR PERMIT PHONE / � yy� <br />f�7 �T Mo�u�Y _ _ S:, ,,,, , ,.., �� yv�- _ <br />e-rna� <br />P�MIT I <br />WNTR. LICENSE N <br />USE OF BU�LDING <br />v��� ��c�u� <br />WORK DESCRIPTION <br />�I,til.OMMU NLC�C <br />NO. I TYPE OF FlXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />W ater hzater <br />Sink (service/6ar/mop/etc.) <br />BackOow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Rool drains <br />Olher <br />HEAT SOURCE CONTRACT PRICE OP WORK <br />N� i.ctric _ Gas _ Other �g �� <br />1 1 Pu�✓i-' � �•tvv�� 1 �'f •�• "�-- 2 <br />( '� IZ�P� (2 )k�Cl �`�I W� � � <br />C4) `rtvV�s �N� �wl N�r f 8) t�f s. <br />�I � <br />NO. I TYPE OF FUCTURE OR ITEM <br />A/C - air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas tireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhausl fan <br />Heatpump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />N�� <br />I hereby ceritily lhat I have read and examined this application and know the same to be true and correct. All provisions ol laws and <br />ordinaces governing this type cf work will be complied with whether specified herein or not. The granting ol a permit does not presume <br />to give authority to violate or cancel the provision of any other st�te or Iocal law regulating construction or the performance of <br />constru Thal I am authorized by the owner of this property to perform the work for which application is made and I comply with ihe <br />State C tr tors La�w 1� 7jjCW and 296.200 WAC. <br />�,�Itill.4�{ V �1 �. 5�� �zb0�l <br />'IL <br />