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SITE ADDRESS <br />PtRMIT APPLICATIC�N <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAP, STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - wvuw.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />TRACT <br />PARCEL TAX I.D. # <br />���� G'/�'A2�� �1� �� T,�oz� ,� �� ��E,�-r> >g�� <br />TENANTNAME � CONTACTFORPERMIT PHONE <br />CONTRACTOR <br />CONTR.LICENSEM �� <br />uomE.a <br />USE OF BUILDING <br />WORK DESCRIPTION <br />- /GA� OF� COi+�l��i%10.•i <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toiiot <br />Bathtub <br />Lava!�ry (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (service/badmop/etc.) <br />Backllow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Greasetrap <br />Rool drains <br />Other <br />ADDRESS CITY2IP <br />���s .snuYN 1.io rw s� <br />— HEATSOURCE I <br />Electric Gas Other <br />PHONE <br />CONTRACT PRICE OF WORK <br />NO. � TVPE OF FIXTURE OR ITEM <br />A/C - air handling unils <br />Forced air syslems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust tan <br />Heat pump <br />Unit healer <br />Boiler <br />Reirigeration <br />Woodstove <br />Olher <br />CIN OF EVERETT IOCAL SALES TAX CODE IS 3105 <br />� hereby ceritify that I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br />ordinaces c�overninc� this lype of work will be complied with whether specified herein or noL The granting of a permit does not presume <br />to give aulhority to violate or cancei the provision of any other state or Iocai law regulaling wnsWction or the performance of <br />construcli That I am aulhorized by the ownor of this property to pertorm the work for which application is made and I comply with lhe <br />Stat� �Conir �clo�s Law 18.27 RCW and 296.200 \'JAC. <br />i � <br />- /1/ --_ -: l� � --�- --� �!/ ./ � il / <br />