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SITE ADURESS �!`� I <br />ZJ � <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />f i c,� a�d <br />TENANTNAME <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 `$ -'�� '"0'6 <br />Ptiub+l-rco 8tva. <br />� � <br />BLOCK TRACT <br />aooae <br />�vgoo � <br />'�(lA5'r' S i <br />PARCEL TAX I.D. # <br />PERMIT 1t <br />� � � CITYRIP PHONE <br />4rc��u.�=� wy n . <br />CONTACT FOR PERMIT <br />N / Ar ' <br />CONTRACTOR -1-p be ���n.i,j� ADDRESS <br />CONTR.LICENSE# �� �� <br />�� <br />USE OF BUIL�ING <br />WORK DESCRIPTION <br />At.wW li ti �tn. 04- hous.c� <br />NO. I NPE OF FIXTURE OR ITEM <br />Toilel <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (servicelbar/mop/etc ) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other __� <br />HEATSOURCE <br />S�-(� �D�•5'25-646 <br />PHONE <br />CITVIZIP PHONE <br />I CONTRACT PRICE OF WORK <br />_Electric,_Gas_Other I � <br />�_ <br />NO. <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handlinq units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clolhes dryer <br />Range hood <br />Exhausl�3n <br />Heat pump <br />Unit heater <br />Boiler <br />IRefngeralion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby centify lhat I have read and examined this application and know the same !o be true and correct. All provisions of laws and <br />t glive authonty to 9iohale oP cancelrlhelprov s on olfe ny othehstate oP ocal aw regulai ngiconslurctlon o�the performance o( Presume <br />construction That I am aulhorized by lhe owner of lhis prcperty to perform the work for which application is made and I comply with ihe <br />Stale Contracrors Law 7827 RCW and 296200 WAC. <br />Signalure of OwnedConlractodAulhonzed Agent <br />Date <br />� <br />