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SITE ADORESS <br />`! Z�-^' i�- <br />LEGA LOT NO. <br />DESC. <br />OWNER <br />�„ ,- J.��. <br />TENANTNAME <br />;�n�� <br />}�i�2'2'�'.� <br />cofrTR. UCENSE N <br />USE OF BUILDING <br />P�RMlT APPLICATI(»V <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-�1857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />L �'�-'1 ST <br />�4anG� <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Balhlub <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwashcr <br />Clolhes washer <br />Water healer <br />Sink (servicelbar/mop/elc.) <br />Backflow prevenlPr <br />Urinal <br />Drinking Foun�ain <br />Floor drain <br />Greaso trap <br />Roof drains <br />Othor <br />PARCEL TAX I.D. N <br />TRACT OR SUBDIVISION N <br />CONTACT FOR PERMIT <br />RJ <br />PERMIT f1 <br />W�' <br />�l Zs ' 3 C�s� <br />l� <br />� <br />J 3C� <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric _ Gas _ Other <br />�� � ���� �o <br />I <br />�'-'i7?/��<< <br />NO. I TYPE OF FIKTURE OR ITEM <br />A/C - air handling units <br />Forced air syslem:: <br />Gas piping <br />Water heater <br />ues (ireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodslove <br />Olher <br />CITY OF EVERETT LOCAL SALES TIV( CODE Ia 3705 <br />I hereby ceritify that I have read and examined this application and know the same to be truc and cortecL All provisions of laws and <br />ordinaces governing lhis lype of work will be complied wilh wholher specified herein or nol. The granting of a permil does not presume <br />to give authority to violate or cancel the provision of any olher state or iocal law regulating consWctlon or the perfortnance of <br />conslruction. That I am authorized by Ihe owner of this property to perlerm the work for which application is made and I amply wilh the <br />Slale Contractors Lay+ 18.27JiCW and 29j'i.200 YVAC. <br />(/Z <br />