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SITE ADDRESS <br />L GA' �NSG <br />DESC. <br />O NER <br />, �% { C <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICEkSE f! <br />USE OF BUILOING <br />WORK DESCRIPTION <br />�� <br />NO. <br />i <br />C ii� <br />P�RMIT APPLICATION <br />CITY OF EVERETT PERMIT SER1�'ICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIUNS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TN( I.D. # <br />fiaG� ✓� <br />BLOCK TRACT <br />/ ADDRESS CIN21P <br />a �,�a �o,23Sau,.��e f���� <br />ICON7Ar,T FOR PERMIT <br />ADDRE55 CITY2IP <br />HEAT SOURCE <br />_ Electric � Gas _ Ofher <br />6 �a -06 <br />PERMIT # <br />y�2a 3 .�y�-. <br />PHONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />%i�Cd �z'1L / // Il li7 - %/G✓h S//'PP/ � �N,St' <br />innaiNr. ..�,,....,.,... <br />TYPE OF FIXTURE OR ITEM <br />Toilol <br />Balhlub <br />Lavalory (wasii basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwashcr <br />Clolhes washer <br />Wa1er healer <br />Sink (serviceNaqmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Greaselrap <br />Roo( drains ' <br />Qther� c���'✓ �1��� <br />-.���.�-,�^•.�.��f� <br />Na• � TYPE OF FI%TURE OR ITEM <br />'v� — air nanaimg unns <br />Forced air systems <br />Gas piping <br />Water heatcr <br />Gas firep�ace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit hcater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher <br />CITY OF EVERETT LOCAL SALES TA% CODE IS J705 <br />I hereby ceritify Uiat I have read and examined ihis applicalion and know Ihe same lo be irue and wrrect. All provisions of laws and <br />ordin2ces c�oveming lhis type of work will be complied wilh whelher specified herein or noL The granling of a pertnit does not presume <br />to give authority to violale or cancel Ihe provision ol any other slate or Iocai law regulating constiuction or the pertormance ol <br />construclion. That I am authorized by ihe owner ol this property lo perform the work for which application is made and I comply with the <br />Slale CbTlractors L�827 RQW an 296.200 WF�C. <br />. �� <br />� � / f �h <br />,� �� z, ���'�r-� �2� ''J �2 d� <br />