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P�RMIT APPLICATIGnI <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 982C1 <br />425-257-881 U- FAX 425-257-8857 - www.everettw2.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS __ / <br />��l �� /(i .7iJr �-,' c �_ <br />LFGAL LOT NO. BLOCK <br />TENANTNAME <br />NT A T R <br />CONTR. LICENSE p <br />USE OF BUILDING <br />� op.,n �� L <br />PARCEL TAX I.D. p <br />TRACT OR SUBDIVISION # <br />�/l ) 7aMn,u+� D2 �v.�,-r9f''-�3 <br />CONTACT FOR PERMIT <br />, , � � �/ � <br />�; � _ �, _� �� � •: <br />WORK DESCRIPTION <br />✓f i / � � `-.� <br />HEATSOURCE <br />Eleclric _ Gas _ Other <br />�����1/���� ���_(�`��'i . <br />ryp. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />BathWb <br />Lavaloq� (wash basin) <br />Shower <br />Kitchen sink 5 uisposal <br />Dishwasher <br />Clolhes washer <br />Waler healer <br />Sink (service/barlmopietc.) <br />6ack0ow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Gre2sc trap <br />Roof drains <br />Othcr <br />i�:�•�:t= <br />�RoSG�-Op� <br />�S as�o �13 <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC — air handling unils <br />ForceA air systems <br />% Gas pipiny <br />Walen c�atcr <br />Gas lireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />[xhauslfan <br />Heat pump <br />Unit healer <br />Boi�er <br />Re(rigeration <br />Woodslove <br />CITY OF EVERETT LOCAI SALES TAX COOE IS 3105 <br />I hereby ceritify that I have read and examined tliis applicalion and know the same to be true and correcL All provisions of laws and <br />ordinaces c�overning this type of work will be complied wilh whelher specif�ed herein or nol The granling o( a permil does nol presume <br />to give authority to violale or cancel Ihe provision of any other slate or local law regulating consWction or the pedormance of <br />construction. That I am aulhorized by the owner of this property lo perTorm the work for which applicalion is made a�d I comply with lhe <br />Sta�e Contraclors law 18.27 RCW and 296.200 WAC. �� <br />1 1 <br />enl <br />�—_ . _- _— <br />