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SITE ADDRESS <br />l C� O 1 <br />LEGAL LOT NO. <br />DESC. <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE q <br />USE OF BUILDING <br />WORK DE•:,CRIPTION <br />P�RMIT APPLICATIGN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - wvuw.everethNa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SIS�' t�L S�` <br />BLOCK <br />PARCEL TAX I.D. # <br />�5� lo�-� oo�t <br />TRACT <br />��S} ��.�'"� <br />CONTACT FOR PERMIT <br />��� � <br />ADDRESS � <br />�VtJ�aJ.� i,; c"� � <br />HEAT SOURCE <br />_ Electric � Gas <br />� cirfrz <br />- l� � <br />Other <br />� �^b.l �'t-vrc,� � �— . <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Tcilet <br />Bathtub <br />Lavalory (wash basin) <br />ShoH�er <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Other <br />�25 ^ <br />a�3-z <br />PNONE <br />`1 � � �r�� -�—r i � i <br />PHONE <br />j l. o Sl� �/�v S-� <br />CONTRACT PRICE OF WORK <br />�� ` � p� o0 <br />3/,7S��o <br />�� �.�F <br />NO. � TYPE OF FI%TURE OR ITEM <br />A(C — air handling unils <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Cblhes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE iS 3105 <br />I hereby ceriti(y thal I liave read and examined this application and know lhe same to be true and cortect. All provisions of laws anc' <br />ordinaces governing this type of work will be complied with whelher specified herein or nol. The granting of a permit does not presume <br />lo give authority to violate or cancel the provision of any olher state or local law regula6ng construcGon or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Slale Conlra9tors Law 18.27 RCW and 296.200 WAC. <br />