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SITE AUDRESS <br />PERMIT APPLICATION <br />CITY �F EVERETT PERMIT SERVICES <br />3200 CE�AH STFiEET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.evereriwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� i.✓, I jGIyP�%3�eI ��36190 5'03�4�i' <br />BLOCK I TRACTOR <br />unncn <br />C�B 'lrr✓t�'"�'n/3 /�1vr�iwF>f CLC <br />TENANT NAME <br />� c3n3--�� <br />�!� %i��0 3�% <br />� J�7 <br />Iip'L <br />ICONTACT FOR PERMIT P�Nt Z� <br />DArv'n�����c.'� e.Ma����� <br />Gl`E.r�'�%/cvhe3 /'Li/Z 3; <br />CONTR. �ICENSE t ( ,r�`SyC�'�;L L.% <br />G YY// <br />USE C�F BUILDINO r <br />:l�g�E' '�a.��� /�Eas"icf��,'C�' <br />WORK DESCRIPTION <br />� �% <br />��,cr yY �G�.S`%7�[lC`%/N/f <br />N0. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtu6 <br />Lavatory (wash basin) <br />uhower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backtiow preventer <br />Urinal <br />Drinking Founlain <br />Floordrain <br />Grease trap <br />Roof drains <br />Other <br />HEATSOURCE <br />_ Electric � Gas <br />CONTRACT PRICE OF WORK <br />Other ������� <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />W ater heater <br />Gas tireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other _ <br />� <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. AII provisions ol laws and <br />ordinaces governii.� this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give ority ta violate or cancel !he provision of any other state or local law regulating construction or Ihe peAormance of <br />cons cC r�. That I am a o' e by the owner4l t' property to perform the work for which application is made and I comply with the <br />Sta C tractors Law .2 and 296.200 C. <br />l�/ 7 <br />S atureo ne tiacto ut onzed ge t Dnte ��� <br />Yr <br />