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SITE ADDRESS <br />LOT NO. <br />TENANTNAME <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAA 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 />PARCEL TAX I.D. # <br />BLOCK I TRACTORSUBDIVISIONI <br />PHONE <br />%-a`+-d1 <br />Z53 <br />� E•MAIL <br />C111 Ik'Ctiin� �4i5t� Brouclu�u�,t < < c (c(o(c� <br />CONiR.LICENSEMCmI�� J�I�G��1."Jry' (����I�i� -I�U�� ��J �, � <br />USE OF BUILDING <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />�/Eleciric _ Gas _ Othcr /�9 � 7� <br />WORK OESCRIPTION �I'1 C fz� �' �� �� / / ,�� �i � G��l L- �Ci� �'� �� ���1'� <br />J� (,I.vLG <br />NO. I TVPE OF FlMURE OR REM <br />Tmlet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothcs washer <br />Water heater <br />Sink (servicc�bar;mop%c1c.) <br />Backflow preventer <br />Urinal <br />Drinking Foun�ain <br />Floar drain <br />Grcasc tr, p <br />Roof drains <br />Other <br />NO. I TVPE OF FIXTURE OR ffEM <br />� <br />A'G - air hantlling unqs <br />Forced air systerns <br />Gas piping <br />Water heatcr <br />Gas fireplace <br />Gas ranpe <br />Clotlies dryer <br />Range twod <br />Exhausifan <br />Hcatpump <br />Uni� heater <br />Boilcr <br />Relrigcrafion <br />Woodstovc <br />CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify ihat I have read and examined ihis application and know Ihe same to be true and correct. All provisions of laws and <br />ordinaces goveming 4iis type ol work will be complied with whether specified herein or noL The granting ol a permit dws not presume <br />to give aWhoniy to violate or cancel the provision of any other state or local law regulating constmction or the perlormance ol <br />construction. That I am authorized hy the owner ol ihis propehy to perform the work lor which application is made and 1 comply with the <br />State Contr ars Law ts.27 RGNy and 296.2001NAC. <br />��1?l��c ��cu-vr ����13 C�� <br />��� <br />