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SITE ADURESS <br />LOT N0. <br />I:L•\LI� <br />LICENSE # <br />USE OF BUILDING <br />PERMIT APPLICATION <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 />f PARCEL TAX I.D. # <br />BLOCK TRACT <br />ADDRESS CITYIZI <br />�', ���. ��5 � � li�l���• �� <br />CONTACT FOR PERMIT <br />�j ADDRESS • CI1Y21P <br />��C�t_ `/y'l�'i 77�Lt-t„C-.—,_____-�.�% E''i�,,.l� <br />HEATSOURCE <br />� � _ Eleclric ✓ Gas _ Olher <br />WORK DESCRIPTION .. ,� <br />�_ .'�� �G 2 �� �_:�Cc�s�>a�r, %f'Q�2,ucJ <br />✓ <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilcl <br />Balh�ub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Wa�er healsr <br />Sink (service/bar/mop/etc.) <br />BackOow pr�venlcr <br />Urinal <br />Drinkinc� Founlain <br />Floor drain <br />Grcasc trap <br />Roo( drains <br />Olher <br />N0. <br />3 �707 <br />°RMIT # <br />�.CJ �<)�'-Cv�� <br />rnvnc , /' „_ <br />�.., <br />���e�d / 3�1�-�yo <br />PHONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />. �'!i ...i�!1 � <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handlinp unils <br />Forced air syslems <br />Gas pipinp <br />Waler healer <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangc hood <br />Exhaust(an <br />Heal pump <br />Unil he2ler <br />Boiler <br />Refrigeration <br />Woodslovo <br />Olher <br />CITY OF EVCRETT LOCAL SALES TA% CODE IS 9105 <br />I hereby cerilify Ihat I have read and examined this application and know Ihe same to be true and correct. All provisions of laws and <br />ordinaces governing this lype of work will be complied with whether speci(ied herein or noL The grantinc� ol a permit does not presume <br />lo give aulhority lo violate or cancel the provision o( any olher state or local la�v regulating consiruction or ihe performance of <br />conslruction. Thal I am aulhorized by the owner of ihis properly to peAorm lhe work lor which applicalion is made and I comply wilh Ihe <br />State Contrac ors Law 18.27 RCW and 296.200 WAC. <br />�� �,'.7i{���,� i� ,C"SP�� ,. � ._l ���LS % <br />