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SITE ADDRESS <br />i <br />`�La } l _ <br />LEGA LOTNO. <br />�C '`I�� <br />TENANTNAME <br />CONTR. LICENSE p <br />USE OF BUILDING <br />Sr-,n�-- <br />WORK DESCRIPTION <br />PERIVIIT 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 />)� <br />BLOCK <br />PARCEL TAX �.D. # <br />TRACT OR SUBDIVISION N <br />PERMIT <br />� (�.) /L-�.i <br />I — HEATSOURCE <br />Electric _ Gas _ Other <br />�r /I � fi� r� DG{dF i,.s r� <br />� <br />NO. I TYPt OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & dispo:;al <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backtlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other _ <br />PERMIT IF <br />G 1 �0 �- �� l <br />CIp PHONE <br />- �faa -�:�a�� <br />PHONE <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling units <br />Forced air systems <br />%— Gas piping <br />Water heater <br />Z Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />� Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cehify Ihat I have read and examined this application and know the same to be true and correcl. All provisions oi laws and <br />ordinances goveming this type of work will be complied with whelher specified herein or nol The granting of a permil does not presume <br />to give authoriry to violate or cancel Ihe provision of any other slale or local law regulating construction or the pedormance of <br />construction. That I am authorized by the owner of this property to periorm the work forwhich application is made and I comply wilh the <br />State CoNradors Law 18.2j RCW and 296200 WAC. <br />i <br />re <br />��'.3—/�� <br />