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LOT NO. <br />NAME <br />� <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•evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />pARCEL TAX I.D. / <br />- ST, � 00�f-3Y73� <br />BLOCK TRACT OR SUBDIVISION R <br />l5a$ l�Atn/u� �Sr <br />ICOHTACT FpOR�P�ERMIT <br />Blef'r.�% /'-�PSJL'LIF� <br />noon � <br />�VYr'Nii�VUrIB(T.d'IiiG-• l4(oi� l3 /i�:Gi�- <br />CONiA.LICENSER p��y��g,{,{�, <br />USE OF BUILDING <br />PERMIT i <br />trn , iva <br />yz5-3!S 38"8� <br />PHONE <br />�2y 7�5�6�f(e� <br />e_uui <br />9� 7 y2s ��s-�Y�� <br />HEAT SOURCE CONTRACT PHIGE OF wun�c <br />,_Electrb �Ges_Other � �1'7'b�O�`� <br />WORK DESCRIPiION RE�µ� �5TI.��- UlL �2'✓'fC� W/%Yi �i" 'V�Ki �E-S %2(.PN�4-('E <br />Tl Sifmy Gc�c,f-rtc�� .4+✓D 2u,v $O � oF Ne�tl (r.f5 <br />NO. I TVPE OF Fl%TURE OH ITEM <br />Tollel <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kltchan sink 8 disposal <br />Dlshwasher <br />Clothes washer <br />Water healer <br />Sink (servicelbar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />� <br />TVPE OF FlICTURE OR REM <br />A/C — alr handling units <br />Forced air systems <br />Ges plping <br />Water heater <br />Gas fireplace <br />Ges range <br />Cbthes dryer <br />Renge hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVEflETT LOCAL SALES TA7C CODE 13 3105 <br />I hereby coritity that I have read and examined this epplication and know the same to be true and cortect. All provisions ot laws and <br />ordinaces govarning thfs typo ot work wili be compiied wilh whelher specitied herein or nol. The granting ot a pertnit does not presume <br />to gtve authority to violate or cancel the provision of any other state or local law regulating construclion or tha performance ot <br />construcli9� That I am authorized by the ow er of this property to perlorm the work lor which applicadon is made and � comply wlth the <br />State,CqfitJlclors Law 1827 a WAC. /�/// <br />�`�'L-7r.� � �i <br />