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SITE ADDRESS <br />� <br />LEGA LOT NO. <br />DESC. ' <br />OWNER <br />1��t��N <br />TENANTNAME <br />�� <br />CONTR. LICENSE # <br />USE OF BUILDING <br />C��.t�a�.� �Pm <br />�� <br />PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVEREIT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PYI <br />PARCEL TAX I.D. S <br />o �35�1 a ��c <br />4CT OR SUBDIVISION,p <br />�y � <br />CONTACT FOR PERMIT PHON <br />� or+r r1HJ �; <br />�J ����L_ �si,�W�-m E•MAIL <br />HEATSOURCE <br />� ElecUic _ Gas _ Olher <br />,a—O <br />�<<� - 4 �i <br />��51�-3tia <br />PRICE OF WORK <br />WORK DESCRIPTION ' <br />KL•v�a��:[.� v:cl �ki,��n;� N�,,as� , o��r.�E 3ir����C1J ��,rti,:�r F�rie,,,,,� <br />N0. <br />PLUMBING <br />TYPE OF FIXTURE OR ITEM <br />Toilel <br />�.rihtub <br />Lavalory (wash basin) <br />Showcr <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (serviceNadmop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease Irap <br />Roof drains <br />Olher <br />NO. I 7VPE OF FI%TURE OR ITEM <br />AIC — air handling unils <br />Forced air systems <br />Gas piping <br />Waler healer <br />Gas fireplace <br />Gasrange <br />Clolhes dryer <br />Range hood <br />Exhausl (an <br />Heal pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br />I hereby ceritify th2l I have read and examined this application and know Ihe same to be true and correcL All provisions of laws and <br />ordinaces �overnin9 this type of work will 6e complied with whether specified herein or not. The granlin� o( a permit does not presume <br />lo give aulhority lo violale or cancel the provision of any other stale or local law regulaling construction or the performance of <br />conslruclion. Thal I am aulhorized by Ihe owner ol Ihis property �o pedorm Ihe work for which application is made and I comply wilh ihe <br />State CoNractors Law 18.27 RCW and 29G200 VJAC. ! <br />� = — —-�..' �' I�'. � <br />--_ ' _.—_ � / �-r ✓ �,(i 1 <br />Si9nalure of O�vner/ onlractodAethbr ed i���enL " Date I� <br />Nsi <br />