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P�.RMIT APPLICATI(i.� <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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />� ,- � <br />LEGA LOT NO. BLOCK <br />oEs� � �� - � o yr � <br />OWNER <br />�i:,vN�Ti' �,e,�k �o,�� <br />TENANT NAME <br />CONTR. UCENSE il <br />USE OF BUILDING <br />�, � /\` � <br />WORK DESCRIPTION <br />NO. I TYPE OF FIXTURE OR ITEM <br />� <br />Toilet <br />Dalhtub <br />Lava�ory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (s�rvice/badmople�c.) <br />6ackflow picventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease�rap <br />Ruof drains <br />Other <br />PARCEL TAX I.D. # <br />�s63a�fv�oz <br />OR SUBDIVISION N J�� /U � C <br />CONTACTFOR <br />HEATSOURCE <br />_ Electric _ Gas _ Olher <br />NO. <br />�(—S—IC� <br />PERMIT p <br />;t«,3-��y <br />�5 �.DD� <br />�e�7is��s — �� z -.� - <br />PHONE <br />�� <br />.'f�F�i9�'FbN �!� <br />�(, w� ���'`'`'. r,3�' 3 <br />�^ <br />I CONTRACT PRICE OF WORY. <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air sys�ems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clathes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit hea�er <br />Boiler <br />Refrigeratlon <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify Ihat I have read mid examined Ihis application and know Ihe s2me lo be true and corred. All provisions of laws and <br />ordinances goveming this lype of work wBl be complied with whether specified herein or nol. The granling ol a permit does no� presume <br />lo give aidhority �o viola�e or cancel ihe provision ol any other sta�e or local law regulating cons�ruction or the periormance of <br />iconstruclion. That I am aulhorized by Ihe owner of this property lo peAorm the work for which applicalion is made and I comply wilh �he <br />, Stale Con�ractors Law 1827 RCW and 296,200 WAC. <br />� ,�J � <br />-r � /' . _ _ !,'_ �z _i a-_ �., <br />2 <br />�/ <br />c <br />