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i� <br />P�RMIT APPLICATION <br />ClTY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />�/� �Z /D <br />Z, 1..✓ _ APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />�1 �/lD <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />.�e �i-d�-e ►�^�L. VI1 I 0! l-(� U <br />LEGA LOT NO. BLOCK � TRACT OR SUBDIVISION M �� �^ _ <br />DESC. <br />ONMER <br />� � � <br />�G2 <br />TENANTNAME <br />I'ii..i�- fo,�ti �k�,`n� �lir� Cee 1��"i <br />CONTR. LICENSE N , , , n,r. _ � , �, , <br />USE OF BUILDING <br />DESCRIPTION <br />NO. � Tl'PE OF FI%TURE OR ITEM <br />Toilet <br />Oathtub <br />Lavatory (wash basin) <br />Shower <br />Ki�chen sink 8 disposa� <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/barhnop/elcJ <br />Backtlow preventer <br />Urina� <br />Drinking I"ountain <br />Floor drain <br />Grease Irap <br />Roof drains <br />Other <br />�Zvc� S�a�k �- c— �+ <br />CONTACT FOR PERMIT PMO�!E <br />E�NIAIL <br />�� <br />l.IITILIY rnvnc <br />(a�rbAvcw ��+wvds wA 9soZcv (�lZs)2�- <br />HEATSOURCE <br />_ Electric � Gas _ Other <br />�� <br />CONTRACT PRIGE OF WORK <br />�Kov <br />NO. I TYPE OF FI%TURE OR ITEM <br />AIC — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhausl fan <br />Heat pump <br />Unit heater <br />Boiier <br />Refrigeretion <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TA7C CODE IS 7105 <br />I hereby certify that I have read and examined this applicalion and know Ihe same to te Irue and coirect. All provisions of laws and <br />ordinances governing ihis type of work will be complied with whether specified herein or not. The granting of a permit dces not presume <br />to give autnonty to violate or ca he provision of any olher state or locat law re �ulating construction or Ihe pedormance of <br />cons�-uction. Thal I am � ed by the owner oi this proHerty to perform the work for which appiication is made and I wmply with lhe <br />State Contractor 27 RCW and 296.200 WAC. <br />