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SITE ADDRESS <br />�_j <br />LEGAL LOTNO. <br />,� ;�, <br />NAME <br />�� 1( :lT� ( -c�� <br />F :RMIT APPLICATI� N <br />CITY OF EVERETT PERMtT 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 />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />CONTACT FOR PERMIT <br />YltUrvt <br />q <br />C T TOR l) --'j ADURE55 � �nriur rnvnc <br />% �I/ )/j� <br />CONTR. LICENSE # � <br />.� N�� �'�./%'#—�- �m--h` !�Z�� Zi7�3Fs9 <br />USE OF BUILDING � HEAT SOURCE I CONTRACT PRICE OF WORK <br />�c�l,-� �--, � <br />WORK DESCRIPTION <br />TI� 5?/Jr ! L.,�,.-� Tc i/ <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />Toilel <br />Ba�htub <br />lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mopletc.) <br />�ackllow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Other <br />Eiectric Gas Other <br />,-� / Z �-�o�,� �,�,,:s <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C - air handling units <br />Forced air syslems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gasrange <br />Clolhes dryer <br />Range hood <br />Exhaust fan <br />Heal pump <br />Unit heater <br />Boiler <br />Re(rigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TA% CODE IS J105 <br />I hereby certify that I have read and examined this application and know lhe same to be true and corred. All provisions oi laws and <br />ordinances goveming lhis type of work will be complied with whether specified herein or not. The granting of a peimit does not presume <br />lo give aulhority lo violate or cancel �he provision of any other state or local Iaw regulating construclion or ihe performance oi <br />conslruction. That I am authorized by the owner of this property to perform ihe work for which application is made and I comply with lhe <br />Slale Conlractors Law 18.27 RCW and 296.200 WAC. <br />7'� �� � �'- :% �/ �S // �' — <br />