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d <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />•925-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS ) <br />JSO'I �, 17��.c.� <br />LEGAL LOT N0. BLOCK <br />DESC. <br />��JL' �, � 11� <br />TENANTNAME <br />PARCEL TAX I.U. # <br />TRACT OR SUBDIVISION p <br />jSL.i'i J, �-��"�t1dC'� i <br />CONTACT FOR PERMIT <br />PERM! �� <br />� o�-� <br />PHONE ItaS-?�j9 -�/ <br />`,� � y �� � J� �� (J <br />-__^ I E-MAIL <br />AD E YI P <br />CONTR. LICENSE # <br />USE OF BUILDING <br />HEATSOURCE <br />,y/ Electric _ Gas _ Other <br />WORK DESCRIPTION —�.� � <br />�1C� C�l.� � � �'-ftA�"�.�lOGrs�O G�-a-�.��<�<•� �Ce/�C2 <'_Q <br />J- <br />NO. I NPE OF FIXTURE OR ITEM <br />� <br />� <br />Toilcl <br />Balhtub <br />Lavalory (wash basin) <br />Showcr <br />Kitchen sink 8 disposal <br />Dishwaslicr <br />Clolhes washer <br />Watcn c�ater <br />Sink (scrviceNarhnop/etc.) <br />Backllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />CONTRACT PRICE OF WORK <br />NO. I NPE OF FIXTURE OR ITEM <br />A/C – air hantllin� units <br />Forced air syslems <br />Gas piping <br />Waler healer <br />Gas fireplace <br />Gas range <br />Cbthes dryer <br />Rangehood <br />Exhausl fan <br />Heal pump <br />Unil healer <br />Bo�ier <br />Re(rigeration <br />Woodslove <br />Other <br />CIN OF EVERETT LOCAL SALES TA7( CODE IS 9705 <br />I hereby ceriti(y that I have read and examined this applicalion and know ihe same to be true and wrrecL All provisions ul laws and <br />ordinaces governing this type of work will be complied with whether specified herein or noL The granting of a permit does not presume <br />to give authority lo violate or cancel lhe provision of any other stale or Iocal la�v regulaling construc�ion or lhe peAormance of <br />conslruc�ion. Thal I am authorized by Uie owner o( this property lo peiiorm the work for which applicalion is made and I comply wilh ihe <br />Slale Conlractors Law 1k327 RCW and 296.200 WAC. <br />��1 �xc;���L���_ 31803" <br />