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SITE ADDRESS <br />� 0 /�11r' <br />LEGA LOTNO. <br />TENANT NAME <br />.�— <br />�t.,cuGTz <br />CONTR. LICENSE.� L <br />y <br />USE OF BUILDING <br />/�v�� <br />WORK DESCRIPTION <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 />BLOCK <br />oL <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION M <br />/�f0/ ,t.�tQp, <br />ICONTACT FOR PERMIT <br />�/S12(�aLQS ,C.wuunwa3 �/6 CDLQY77B <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitch �n sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (servicelbarlmop/etc.) <br />8ackflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Uther <br />HEAT <br />_ Eleclric _ Gas _ Other <br />PERMI7 # <br />��S �7� <br />PMONE <br />3sfr�S�.r <br />PRICE OF WORK <br />`UDO� <br />N0. I TYPE OF FIXTURE OR �TEM <br />� A/C — air handling unils <br />Forced air systems <br />� Gas piping <br />Water healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Renge hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby certify that 1 have read and examined this application and know the same to be true and correct. A�I provisions of laws and <br />orJinances governing this type of work will be complied with whether specified herein or not. The granting ot a pertnit does not presume <br />l0 9ive authority to violate or cancel the provision of any other state or local law regulating construction or the perfcrtnance of <br />construction. T t I am authorized by the owner of lhis property lo perform the work ior which application is made and I comply with the <br />State Contr�2�aw 18.27 R W and 296200 WAC• /� <br />l� .i- /t/ <br />