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� � ��o�/ <br />SITE ADDRESS <br />0.�� �v �-� <br />LEGAL LOTNO. <br />DFoC. <br />P�RMIT APPLlCATI(.,N <br />CITY OF EVERET7 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 />BLOCK <br />� �� <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION if <br />� 93 � �,�: <br />CONTACTFORPERMIT <br />PERMITat <br />o/ i'''1 �% � y� �'->> <br />21P PHONE <br />%J7�'.1�J7 OlJ�I% <br />PHONE yas -�sy- y��� <br />pla.•/, c� <br />CONTR. LICENSE N <br />D S�!? eLooO � � <br />USE OF BUILDING H[AT SOURCE CONTRACT PRICE OF WORK <br />�,-� f� � y� _ Eledric _ Gas _ Olher Y`f�G:e� c�' <br />WORK DFSCRIPTION <br />1 <br />;��{rr.�:��_ ��_ ;-�-��5 �/ �r��s <br />� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & dispos2l <br />Dishwasher <br />Clolhes washer <br />W alcr heatcr <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urin21 <br />Drinking Pountain <br />Floor drain <br />Grease trap <br />Rool drzins <br />Olher _ <br />NO. I 7YPE OF FIXTURE OR ITEM <br />A/C — air handling uniis <br />Fomed air syslems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Rangehood <br />Exhausl(an <br />Healpump <br />Unit heater � <br />Bai�e� / <br />Refrigeralion 2 e,��pc -C� � <br />Woodslove <br />Other /2 % -� os 4�S <br />� S � �7L1 <br />CITY OF EVC-RETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerilify Ihal I have read and examined Ihis application and Y.now lhe same to be lrue and correcl. All provisions of laws and <br />ordinaces governing this type o( work will be compliod �+�iUi whelher spucilied herein or noL The granting ol a permi� does not presume <br />lo give aulhorily to violale Pr cancel Ihe pro��ision O( an�� other stale or local law regulating construction or the pertormance ol <br />conslp�Ctionl Tlial I am aulhorizeA�by llie,oWilef of,lhis property to peAorm the work for u�hich application is made and I comply with the <br />SI�tC: Contr�`�dors Law`1027 RC��' �1�fL�9�. OO.WAC. <br />�%« %; �;' ;�.__�. � %-�� U� <br />� s���a�� <br />L� _ <br />