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SITE ADORESS <br />S�TOZ S <br />LEGA LOTNO. <br />1.7Aff� I�� <br />TENANT AME <br />F' /� f <br />CONTRACTOR <br />P�RMIT APPLICATION <br />CITY OF EVEl2ETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — vwvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. /! <br />� <br />BLOCK TRACT <br />i `I U L $. �, �-�, <br />CONTACT FOR PERMIT <br />I�Affv I��a/'�^-.� <br />CITY2IP <br />CONTR. LICENSE p <br />��( ) rS'�� <br />USE OF BUILDING <br />�yeS��lc--;ttG,� <br />WORK DESCRIPTION <br />NO. I TiPE OF FI%TURE OR ITEM <br />Toilel <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Cbthes washer <br />Water healer <br />Sink (service/badmop/elc.) <br />Backflowpravenler p,..yi, ��<•�.�:� <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greaselrap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ Eleclric _ Gas _ Olher <br />�RMIT M <br />� (,��7-� <br />3 �kLs>.;.3y- <br />PHONE <br />y�ris39-Y�� <br />PHONE <br />CONTRACT PRICE OF WOFR <br />NO. I TYPE OF FIXTURE CR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />W ater healer <br />Gas fireplacc <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhauslian <br />Hcat pump <br />Unii healer <br />Boiler <br />Re(rigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y that I have read and ezamined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing (his type of work will be complied wilh whether specitied herein or noL The granting o( a permil does not presume <br />to give aulhoriry lo violale or cancel lhe provision ol any other state or local law regu�ating construction or the perform2nce o( <br />construclion. That I am aulhorized by the owner of this property lo perform lhe work for which application is made and I comply with the <br />State Coniractors Law 1/8. 7 RCW and 296.200 WAC. � / <br />. . � /l/� -�/7 � �i i <br />