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SITE ADDRESS ,^ <br />���oo -%v���� <br />LEGAL LOT NO. <br />DESC. <br />vrrncn � <br />:-'�Zl � l C� <br />TENANT�AME <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />PcRMIT APPLICATIUN <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 />�%�/�,1��'.1S U�-- <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Dalhtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (serviceNadmop/elc.) <br />Backllow prevenler <br />Urinal <br />Drinkinc� Fountain <br />Floor draiu <br />Greas^ lrap <br />Roof drains <br />Olher <br />� PARCEL TAX I.D. # <br />TRACT <br />ADDRESS <br />CONTACT FOR PERQMIT� <br />��j�/IYiS F�oa <br />Mo�+ens <br />ADDRESS <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />� <br />cirvrzia <br />i�3-ob <br />IIT # <br />;.r; � .. rn <br />PHONE <br />2D(o-3510-3�og <br />PHONE <br />I�ACT PRICE OF WORK <br />iJ Ci �i, �) <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas pipinc� <br />W aler heater <br />Gas (ireplaco <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit hcater <br />� doiler <br />Refric�eralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br />I hereby ceritity Ihal � have read and examined Ihis application and know the same lo be true and correcL All provisions of laws and <br />ordinaces �overning thi; lype of work will be complied wilh whether specified herein or noL The c�ranting o( a permit does not presume <br />lo givc authority to violale or cancel ihe provision of any other slate or Iccal law regulating construction or iho pedormance o( <br />construclion. That I am authorized by lhe o�vner o( lhis properly lo perform lhe work for which app�ication is made and I comply wilh the <br />Stale Cunlractors Law 18.27 RCW and 296.200 WAC. <br />— } —�, <br />