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SITE ADDRESS <br />�` pla sl"� <br />LeGAL LOT,NO. <br />DEoC. .�� � � � <br />TENANiNAME <br />CONTRACTOR <br />(��rRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CFDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-25'-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />S�� . oos� 3��111 C� <br />BLOCK TRACT <br />y ll ��.u',��.��4� <br />ADDRESS <br />'O�o� 5'T 4iL � � �.I <br />ICONTACT FOR PERMnIT <br />1� f'fl W qC` � <br />ADDRESS <br />� <br />PHONE <br />)6 "59S•�(,�a- <br />CITY2IP PHONE <br />C� <br />CONTR.LICENSEp �,��ii��-vc� <br />USE OF BUILDING — HEAT SOURCE � NTRACT PRICE OF WORK <br />"11! S� ��(l�+ w� Eleclric x Gas _ Olher _ <br />WORK DESCRIPTION � � ^ / ���� <br />-��w G��;���/� <br />`J�i?L� /K!'�(.,�'�_ ...- <br />�uw�llnwl <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Cblhes washer <br />W ater heater <br />Sink (serviceNadmop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />GfeaSe�rap <br />koof drains <br />Olher ._ <br />N0. I TYPE OF FIXTURE OR ITEM <br />.4IC - air handliig units <br />L Forced air systems <br />i Gas pipiny <br />� bValer heat�r <br />� Gas fireplace <br />1 Gas rango <br />� Clothes dryer <br />� Range hood <br />Exhauslfan <br />Heat pump <br />Unit heater <br />8oiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br />I hereby ceritify lhal I have read and examined this application and know the same to be lrue and correcl. All provisions uf laws and <br />ordinaces goveming this type of work will bo complied wilh whether specifiad herein or c�l. The granling o1 a permit do�:s nol presume <br />to give aulhority to violale or cancel lhe provisioo of any other stale or local la.v rec�ulaling conslruc' i or Ihe pertormance of <br />conslruclion. That I am avlhorized by the owner of this property to perform the work tor which apphcalion is made and 1 comNly wilh the <br />Slate Contraclors La�v 18.27 R �W and 296200 WAC. <br />�' � ��.�-�..�\9� '� / � o�_ ,� <br />J�\N`('��.r_�._.,..in.�r�,�nvndGnan�—�—r— Date Z <br />