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P�RMIT APPLICATI(.,N <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 />SITE ADDRESS <br />�6 '0 Xav � r <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />,����� ,/,,,��� <br />TENANTNAME <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION k <br />(� X�c ✓( e � ri�2 y �i/efe7T <br />CONTACT FOR PERMIT <br />rHONe <br />PERMIT <br />I E-MIUL <br />TR �/'1 I / H E <br />�! 1.:��'1 �� �004/�✓ <br />CONTR. LICENSE il <br />USE OF BUILDING <br />�% � 't� <br />WORK DESCRIPTION <br />UtiE YC.r�� u" r7l!/� l� <br />PLUMBING <br />NO. I TYPE OF FIXTUR[ OR ITEM <br />Toilet <br />Dalhtub <br />Lavalory (wash besin) <br />Shower <br />Kilchen sinh & dispos�l <br />Dishwashcr <br />Clolhes washer <br />W aler heater <br />Sink (servicelbarhnoplelc.) <br />6ack0ow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grcasc lrap <br />Roo( drains <br />Other�i' �VC _ <br />HEATSOURCE <br />_ ElecUic _ Gas <br />Olher <br />_9� <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC - air handlinc� units <br />Forced air syslems <br />Gas piping <br />Water healer <br />Gas fireplace <br />Gasiange <br />C�othes dryer <br />Range hood <br />Exhaustfan <br />He2ipwnp <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodslave <br />Olher <br />CITY OF EVERETT LOCAL SALES TA7C CODE IS 3105 <br />I hereby ceritily :hal I have read and examined lhis application and know the same to be lrue and covect. All provisions of laws and <br />ordinaces goveming this lype ol work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give aulhority to violale or cancel lhe provision of any other slale or local law regulaling consWction or Ihe pertormance of <br />consiruction. Thal I am auth�oJized by lheiowner ol ihis properly lo pedorm lhe work for which application is made and I comply with the <br />StateContr,3ctorsLa� �27RGW.apd29�6.� VJAC. <br />. '/S�i 77�%�:"J�'��.�;��C�' `�`,J/��C/ <br />