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SITE <br />LOT N0. <br />i n t�an <br />CONTR. LICENSE # <br />OF BUILDING <br />1 <br />PERMIT APPLICATION � Lo� <br />CITY OF EVERETT PERMIT SERVICE9� (`c�,� ,� <br />3200 CEDAR STREET, EVERETT, WA 98201 ��-'/(��-- �,' �.r `-_�- �'''.;' �'�;� <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org n, `i ! +� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ���4 r I� <br />BLOCK <br />`l� <br />.� <br />PARCEL TAX I.D. k <br />TRACT OR SUBDIVISION # <br />'\ -CONTACT FOR PERMIT <br />JC,I.� l�i� 1 'L <br />HEAT SOURCE <br />_ Eleclric � Gas _ Other <br />WORK DESCRIPTION 1��-f�� � L� � G ��1 � <br />NO. I TYPE OF FIXTURE OR ITEM <br />__ . _ Toilel <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />' _ CI�.L Iq�••��i��di71�I11Q�?:nir, 1 <br />Backllow preventcr <br />Urinal <br />Drinking Founlain <br />Roor drain <br />Grease lrap <br />Roof drains <br />Other __ <br />�� <br />PHONE p�()(� <br />�cUm�.c n� <br />Cj�t�6 <br />�_. _,.,- . <br />c nnan <br />CONTRACT PRICE OF WORK <br />� (v(X`O . 0 � <br />N0. I TYPE OF FIXTURE OR ITEM <br />_�_ A�C - air handling unds <br />__ Forced air system, <br />Gas piping <br />Water healer <br />Gas tireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhausl lan <br />Heal pump <br />Unil heater <br />Boiler <br />Re(rigera�ion <br />Woodstove <br />_—I — -- -- — <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />I hereby cenuly Ihat I have read and exainined this app6calion and know the same to be true and conacL All provisions ot laws and <br />ordinaces goveming Ihis type ot work will be complied wilh whether specitied herein or not. The graNing of a permit does not presume <br />lo give authority �o violate or cancel Ihe provision of any other slate or local 12w regulaling conslruction or ihe performance of <br />con 1 ction. Thal I am aulhorized by the owner ol ihis properry �o perlorm the work 1or which application is made and I comply wi�h the <br />SI le ntr;�ctors Law 1827 W and 296200 WAC. <br />, (� r, n�� .� a ��-�� � �- I I � (1 �1 <br />