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SITE ADDRESS <br />LOT N0. <br />DESC <br />.�n.,,.�.,�. � <br />(%l, � v;'(/,�[%l: <br />VTR. LICENSE # \ <br />USE OF BUILDING <br />� WORK DESCRIPTION <br />PtRMIT APPLICATIVN <br />CITY OF EVEREI T PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-0810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM <br />PARCEL 7AX I.D. # <br />(t,l✓� -- c U1F3 � <br />BLOCK TRACT OR SUBDIVISION # <br />ADDRESS ��TY�G <br />� ,� <br />5 _��7G ',v NIC,k''.-1-� �; Fi.c> <br />CONTACT FOR�RMIT � <br />I i� , �'1 I <br />,�r7 <br />NO. I iYPE nF FIXTURE OR ITEM <br />1_ <br />� <br />Toilet <br />�athtub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes �sashcr <br />Walen c�ater . <br />Sink (service/badmop/etc.) <br />Back(low preventer <br />Urinal <br />Drinking Founlain <br />f loor drain <br />Grease trap <br />Roo( dr ns <br />Olher t � `�- - �� . <br />���". <br />. `'�!� �iC�/�!��\"v <br />�/ �23�1 1 <br />HEATSOURCE <br />_ Electric �� Gas _ OUier <br />PE� <br />_a5�o�i <br />T# <br />� f%/1�%- �C� <br />JS PHONE �yzSJ <br />��� 3 �� -- �/9/�l <br />IONE ��fz s J <br />MAIL�� ( — ��L� <br />PHONE !� <br />r ( S_— <br />i=/i? �39-7iB"� <br />CONTRACT PRICE OF WORK <br />�'v <br />�/G C�C-' <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Waler healer <br />Gas fireplace <br />Gas range <br />Clolhes drycr <br />Rango hood <br />Exhaust lan <br />Heat pump <br />Unil healer <br />Boiler <br />Re(rigerelion <br />Woodslove <br />Olher <br />CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br />I hereby cenli(y lhal I have read and examined lhis applicalion and know the same l0 6e Irue and correcl. All provisions of laws and <br />ordinaces governing this lype o( work will be complied with whether =pecitied herein or not. The gra�ling o( a permit does not presume <br />lo gi��e authority lo violate or cancel lhe provision o( any other stata or Iocal law regulating consWclion or the peAormance of <br />construclion. Thal I am aulhorized by lhe owner o( lhis property lo per(orm the work tor wh�ch application is made and I comply with the <br />Staty�Contractors Law 18.27 RCW and 296.200 WAC. <br />