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SITE ADDRESS <br />d��`'g c� 1 /L, <br />LEGA LOT NO. <br />DESC. � . —, <br />TENANTNAME <br />�� <br />PERMIT APPLICATION <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 />BLOCK <br />PARCEL TAX I.D. # <br />SUBOIVISION <br />ICONTACT FOR PERMIT <br />' �� <br />UKrJS �.n nc�r rn�nc <br />b;�- T�C. S d�'ii'� S� SE E..lnv�-}- W,4 `�J�B <br />CONTR. LICENSE # <br />�/�s -3� � s 7ya <br />USE OF BUILDING � HEAT SOURCE I CONTRACT PRICE OF WORK <br />WORK DESCRIPTION <br />��hS-}rv,c�or� �� <br />I_ Eleciric _ Gas _ Olher <br />�CPC�,S� C'o✓ICC�-}e b�c� <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />8athtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />BackFlow prevenler <br />Urinal <br />Drinking Fountain <br />F!oor drain <br />Grease trap <br />Roof drains <br />Other <br />�-l1A � �- <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling u iits <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gasrange <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodslove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 37�5 <br />I hereby certify that I have read and examined this application and know the same to be lrue and cortect. All provisions ot laws and <br />ordinances governing lhis type of work will be complied with whether specified herein or not. The granting of a pertnit dces not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the peKortnance of <br />construct' That I am authorized by the owner of this property lo perform the work for which application is made and I compty with the <br />State Contr tors Law,lq.27 RCW and 296.200 WAC. � , <br />1�2 <br />