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SITE ADDRESS / 0 0 3 <br />�:•,�� <br />LEGAL l0T NO. <br />DESC. <br />TENANT <br />PEKMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98?01 <br />425-257-8810 - FAX 425-257-8857 - www.even:ttwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />oed�n�u.� ��V2� pA�tCELTAXI.D.# <br />�,3� <br />BLOCK TRACT UR SUBDIVISION p <br />AOURESS <br />%!� [� � �iinn� �r�,� � �/r> �! <br />� CONTACTFORPERMIT <br />PHONE <br />PERMI: # , <br />' � I ), �� - .'1 �' <br />I E•MAiI <br />CONTRACTOR AD RE S I IZIP P NE <br />G- �! .5 %%uf��ny 5�u � ,1����i�2 i'Y1on�^o � 98a'7� 3�0 ?�1i'-`7306 <br />C/ONTR. LICENSE t! (�� n y <br />1-r.7/-1/—��'. � /�`�,�C I\ <br />USE OF BUILDING <br />WORK DESCRIPTION <br />`'� �l `� �'G Cj �i S <br />J � <br />HEATSOURCE <br />_ [leclric �Gas _ Olher <br />�i.tr<'�czc� C/ictl�lqe-oi.l� <br />V <br />NO. I TYPE OF FIXTURE OR ITEh1 <br />Toilet <br />Bathlub <br />Lavalory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwashcr <br />Clothes washer <br />Waler heater <br />Sink (service/badmoplelc.) <br />Backllow prevenler <br />Urinal <br />Drinkin� Founlain <br />floor drain <br />Grease trap <br />Rool drains <br />Other <br />CONTRACT PRICE OF WORK <br />U� .06 <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC - air ha�dling units <br />Forced air syslems <br />Gas piping <br />1Nater healer <br />Gas (ireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhauslfan <br />Heal pump <br />Unit heater <br />Doiler <br />Refrigeralion <br />Woodstave <br />Other <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />I hereby ceritify that I have read and eramined Ihis application and know the same to be true and correcl. All provisions of laws and <br />ordinaces goveming this type of work will be complied with whether specified herein or noL The granting o( a permit does not presume <br />to give authority lo violale or cancel the provision of anq olher slale or local law rec�ulaling construclion or the performance of <br />conslruction. That I am aulhorized by Uie owner ol lhis property lo perform Ihe work for which application is made and I comply wilh the <br />Slale Contraqlors I.aw 82 : RCW and•2'�u. 00 UVAC. <br />�-i .��-'/ %'�/%,> >, ��� ��> >? <br />� ;. <br />