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SI[T.E� yA^D�DRESS <br />4 OL.�� J . �i <br />LEGA LOT NO. <br />DESC. <br />PE'�:MIT APPLICATIO�. <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 />APPUCATIC �S ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />BLOCK � TRACT OR SUBDIVISION p <br />PERMIT p <br />n�c�o°3 - <br />OWNER ADDRESS CITYIZIP PHONE <br />�����, � C. �:J � ti w� '� �-� `��. �,,..� �}-�•� � �>>�3 U�s �a�c <br />TENANT NAME CONTACT F^,'rt PERMIT PHONE <br />E•MAIL <br />NT ,.ODR , � I <br />CONTR. LICENSE N�� I�, J� � <br />USE OF BUILDING <br />WORK �ESCRIPTION <br />r° <br />,d� zl �-l.�,fi- �,�. I <br />��-.r�i Ci.,� -SE.-��✓IL'L <br />HEATSOURCE <br />y. Eleciric _ Gas _ Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />�alhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes wasl,er <br />water healer <br />Sink (service/badmop/elc.) <br />Oackllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Uap <br />Roof drains <br />Olher <br />CONTRACT PRICE OF WORK <br />�sS �'D <br />N0. I TYPE OF FI%TURE OR ITEM <br />A/C — air handling unils <br />_ Forced air systems <br />_ Gas piping <br />Water heater <br />Gas firepface <br />Gas range <br />Clothes dryer <br />Range liood <br />Exhaust tan <br />� Heal pump <br />Unit heater <br />Boiler <br />Relrigeration <br />Woods�ove <br />Other <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3705 <br />I hereby certify Ihat I have read and examined Ihis application and know Ihe same to be Irue and correcL All provisions of laws and <br />ordinances yoveming this type of work will be complied with whelher specified herein or not. The granting of a permit does not presume <br />to give aulhori�y �o violate or cancel Ihe provision of any other stale or local law regula�ing construction or Ihe pertormance o( <br />construclion. That 1 am authorized by Ihe owner of Ihis propehy to perforrr, the work for which application is made and I comply with the <br />Stale Contractors Law 827 RCW and 296200 WAC. <br />� � � <br />�� ��'� ,1� �-S-I( 1 <br />