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,;� <br />SITE ADDRES:� <br />�S� l 6(.�.. �( Pc�% <br />LEGAL LOT NO. <br />DES(:. <br />P�RMIT APPL'ICATIGnI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CFDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8F 57 — v�nvw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />BLOCIC TRACT OR SUBDIVISION fl <br />PERMIT# <br />-� <br />OWNE'ri Hwrtcw ..�� �,...� ..._.._ <br />l. c� �.,, � F� cc v������ :"�;'�, r'.c rr �� s� ?_s9 �a �9 <br />� �.W� � <br />lEtl:NTNAM�. I COJTACTFORPERMIT PHONE <br />IE-MAIL <br />CONTRACTOR ADDRESS CITY/IP HONE <br />CONTR. LICENSE t! <br />�. �,n 1r-� � _ <br />US[ OF BUILDING HEAT SOURCE <br />j � �. ' _ Eleclric _ Gas _ Olher <br />� <br />WORK DESCRIPTION <br />7 . <br />L::�7�,.'> //`-.�' �.✓-� <br />N0. � TYP[ OF fIXTURE OR ITEM <br />Toilet <br />L�alhtub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water healer <br />Sink (service/badmop/etc.) <br />Back(low prevenler <br />Urinal <br />Drinkinq Founlain <br />Floor drain <br />Grease irap <br />Roof drains <br />Olher _ <br />CON7RACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC - air handling units <br />Forced air systems <br />Gas piping <br />Walcr healer <br />Gas fireplace <br />Gas ranc�e <br />Clolhes dryer <br />Ranc�e hood <br />Exhaustlan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigetalion <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TFJC CODE 151105 <br />I hereby ceritify ihat I have read and examined lhis applicalion and know the same to be true and correcl. All provisions of laws and <br />ordinaces govcrning this type of work will be compiied with �vhether specifieJ herein or noL Tha granting o( a Permit does nol presumr, <br />to give authority to violate er cancel ihe provision ot any other slale or local law regulaling construction or Ihe performance of <br />construr,tion. Tha� I am aulhorized by the owner of this property to peAorm the work for which applicalion is made and I comply with the <br />, Slale� nlraclors La� 78.27 RCW and 296.200 WAC. i <br />.� � ? ����' �',�-� �" � <br />�:;. <br />SignaWre of Ownerl ontraclodAulhonzed Agenl Uala <br />