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r' <br />SITE ADDRESS <br />, <br />LEG L LOT NO. <br />DESC.I <br />1 <br />bwNea <br />� /�� �+ t. <br />TENANTNAME <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EV[RETT, WA 96201 <br />425-257-8810 - FAX 425-257-8857 - v,�ww.everettwa.org <br />APPLICATIONS ARE ACCFPTED FROM 8 AM TO 4 PM <br />BLOCK <br />. , (��,,t" <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION tt <br />ADDRESS <br />P�nt3 y?U� 2sz�� <br />CONTACTFORPERMII <br /># <br />Z <br />�ZIP PHONt , `, �� <br />�'z, -_4�,.. <br />r���;"���J�; i� <br />PHONE <br />I E-MAIL <br />CONTRACTOR ADDRESS CITYIZIP PHONE <br />CONTR. LICENS[ it <br />USE OF BUILDING <br />WORK DESCRIPTION <br />��r��� <br />� <br />HEATSOURCE <br />Eleclric _ Gas <br />��,�n��� r 1�- I <br />NO. I TYPE OF FIXTURE OR ITEh7 <br />Toilel <br />6alhWb <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & d�sposal <br />Dishwasher <br />Clolhes washer <br />W aler heater <br />Sink (servicelbaqmop/elc.) <br />Back(low preventer <br />Urinal <br />Drinking FouMain <br />Floor drain <br />Greasc lrap <br />Roof drains <br />Olher <br />CONTRACT PRICE OF WORK <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handlinc� units <br />Forced air syslems <br />Gas pipinc� <br />Waler heater <br />Gas lirepl.c: <br />Gas ranye <br />Clothes dryer <br />Rangchoo� <br />Exha ��' �an <br />Healpump <br />Unit hcaler <br />Boiler <br />Re(ric�er�tion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TNC COOE IS 3705 <br />I <br />� I hereby ceritify that I have read and examined Ihis applicalion and know the same to be true and correcL All provisions o( laws and <br />I, ordinaces governing this lype of work will be cumplied wilh whether specified herein or noL The granting ot a permil does not presume <br />�Ilo give authority lo violate or cancel the provision of any other state or bcal law regulating construction or lhe periorm2nce of <br />construcfion. That I am aulhorized by Ihe owner ol lhis property �o pertorm the work for whir,h applicalion is made and I comply �•iilh lhe <br />�, State CoNradors Law 18.27 RCW and 296.200 WAC. � � ,; <br />��� <br />._.t�r✓ <br />