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SITE AD�RESS <br />�t � icl x� �d <br />LOT NO. <br />PERMIT APPLICATION <br />CITY OF FVERETT PERMIT SERVICES <br />3200 CE�AR 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 />S[J <br />BLOCK <br />PARCEL TAX I.D.It <br />TRACT OR SUBDIVI:ION M <br />� <br />I•p4t q4 <br />�y.�xS� <br />;oY4 x L� <br />PERMIT # <br />� �'r�n9 - L� <br />;ITV21p PHONF_ LS' <br />....��,�.- 4e�n: 9R/.. <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />SA�I��IE I S/*ME E-MAIL <br />CONTR. LICENSE p <br />USE OF BUILDING <br />awNEK - suic.�E2 <br />C9.4Kd66'I Sf,�oP �DECtC <br />I N <br />HEAT�OURCE <br />Eleclric ✓ Gas __ Other <br />WORK DESCRIPT 0 <br />REMO(/E E,C/ST/�b DEC� �P�r�a <br />wirM DEc�-TOP .su�cF�.cF. <br />NO. I TYPE OF FlXTURE OR ITEM <br />Toilet <br />Ba�hlub <br />Lava�ory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water healer <br />Sink (service/bar/mop/elc.) <br />Backflow preventer <br />Urinal <br />Drir��:ing Foun�ain <br />Floor drain <br />Gieasetrap <br />Roof drains <br />other X6D/�?IUf_ �1�7� Id/ SL�48 <br />CONTRACT PRICE OF WORK <br />.4DD b.4RAC�E �s�oP A1e,R1 <br />NC. I TVPE OF FI%TURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />W2ter heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaus�fan <br />Heatpump <br />Uni� heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TA% CODE IS 3105 <br />I hereby cerilify that � have read and examined ihis application and know ihe same to be irue and correc�. All provisions of laws and <br />ordinaces governing ihis �ype of work will be complied with whether speci(ied herein or not. The granting of a permit does not presume <br />to give aulhoriry to violate or ca el the provision of any other state or local law regula�ing construction or the performance o! <br />constructio , hat I am3� h z by the owner ol this property to perform ihe work tor which application is made and I comply with the <br />S�ate Co ractors Law/j9. W and 296.200 WAC. <br />r/� <br />