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SITE ADDRESS <br />�d�� <br />LEGA LOT NO. <br />� <br />TENANTNAME <br />CO TRACTOR <br />+�7�P��7D/: <br />CONTR. LICENSE p <br />Pt�MIT 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 />,�c,�e� <br />BLOCK <br />USE OF BU/ILq ING <br />��r�i/ <br />WORK UESCRIPTION <br />PARCEL TAX I.D. ft <br />TRACT <br />aVNTAGiFORPERMII <br />ADDRESS <br />�2%cc' �'�✓c . <br />��✓'6�.c� <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposai <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/elc.) <br />Back�ow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Foof drain � <br />Other� d/� <br />CITYIZIP <br />8r�c 2�� �/�9f1,o1� <br />_ / � - � (�. <br />HEATSOURCE <br />_ Electric _ Gas _ Other <br />PERMIT � <br />po5 d �-Qa3 <br />PFiONE <br />PHONE z� <br />�N. 763 - 7"/G� <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF Fli(TURE OR ITEM <br />NC — air handling units <br />Forced air systems <br />Gas piping <br />Waten c�ater <br />Gas tireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Ro(rigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be lrue and cortect. All provisions of laws and <br />ordinaces goveming this type of work will be complied with whether speci(ied herein or not. The granting of a permit does not presume <br />to give authoriry to violate or cancel the provision of any other stale or local law regulating construction or the perfortnance of <br />consiruction. That I am aulhorized by the owner of this property to periortn the work for which application is made and I comply wilh the <br />State Contractors Law 18� R W and 296.200 WAC. ���' �� <br />/7 <br />C.� <br />