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SITE ADDR S <br />b'► <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />_ e- � <br />'[�NANT NAME <br />�� 1 � <br />����� <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />PERMIT APPLI�ATION <br />CITY OF EVERETT PEF2MIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 Cr���� <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org L <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />�v <br />BLOCK TRACT <br />ADDRESS <br />C <br />� c�U���� 1���. /�'rz 1��, <br />/ CONTACT FOR PERMIT <br />r' (� <br />ADDRESS <br />NEAT SOURCE <br />Eleclric Gas Other <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITC-M <br />�� Tollel <br />Balhtub <br />� Lavatory (wash basin) <br />� Shower <br />Kitchen sink & disposal <br />Dish�.vasher <br />Clothes washer <br />Wa1er healer <br />�� Sink (service/bar/mop/etc.) <br />Backllow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Irap <br />Roo( drains � <br />� Other lj����_ <br />N0. <br />� <br />IPERMIT # <br />�'o(�o�- cx;! �l <br />!IP PHONE <br />: �C �^ <br />PHONE <br />CITY2IP PHONE <br />CONTRACT PRICE OF WORK <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas piping <br />Watcr healer <br />Gas hreplace <br />Gas range <br />Cbthes dryer <br />Range hood <br />Exhaust (an <br />Fleal pump <br />Unit healer <br />Boiler <br />Refrigeralion <br />VJoodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby cerilify that I have read and examined this application and know lhe same to be lrue and correcL All provisions of laws and <br />ordinaces c�oveminc� lhis lype of work will be wmplied wilh �vhelher speci(ed herein or noL The grantin� of a permit does nol presume <br />to give aulhorily to violate or cancel the provision o( any other stale or local law rec�ulatiny construction or the per(ormance o( <br />construclion. That ! am authorized by the owner of this property to peAorrt: lhe work for which application is made and I comply with the <br />Slate-CorRraclors Law 18.27 RCW and 296.200 WAC. <br />