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SITE ADDRESS <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />_ 'V Ip(t�l (SAL` <br />TENANT NAME <br />P�.RMIT APPLICATIG��I <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 AF'tE ACCEPTED FROM 8 AM TO 4 PM . �.S <br />PARCEL TAX I.D. # �ERMIT # <br />� L�RI;T o 0000 00 0�> <br />BLOCK TRACT OR SUB�IVI51 N k <br />ADDRESS CITYIZIP PHONE <br />� J � � ^-, "Y • <br />CONTACT FOR PERMIT PHON ° �� � . <br />. V I�I N �7��� � V E•MAIL �i I1 �� �1'� <br />CONTR. LICENSE N O�i.�F-ti+E� , �� �- ^^ �1 ��� <br />�� <br />USE OF BUILDING�,�� (�1��( J���'��� HEAT SOURCE <br />'f <br />�de� p('+. � _ Electric _ Gas _ Other <br />` 1 K! ��-'1 <br />WORK DESCRIPTION � __ A�R�,_„f) 1 � � �,l - �0 <br />�Jl1lXSJFl�Lj�2Q� �C <br />PLUMBlNG <br />TYPE OF FIXTURE OR ITEM <br />� Toilet <br />� Balhtub <br />�` Lavatory (wash basin <br />�c Shower <br />_� Kilchen sink 8 disposal <br />� Dishwasher <br />�_ Clothes washer <br />_� Waler heater <br />_� Sink (service/bar/mop/etc.) <br />� BackFlow preventer <br />� Urinal <br />v� Drinking Fotm�ain <br />� Floor drain <br />x Grease trap <br />c Roof drains <br />�I Other <br />CONTRACT <br />NO. I ' TYPE OF FIXTURE OR ITEM <br />�_ A/C - air handling units <br />Y: Forced air sys�ems <br />� Gas piping <br />v Water he <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Lnit heater <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />� <br />o,� <br />t�3'82. <br />M� �� <br />WORK <br />I hereby certify that I have read and examined ihis application and know ihe same to be true and correct. All provisions of laws and <br />ordinances governing ihis type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority lo violate or cancel ihe provision o( any o; .er state or local law regulating consirudion or ihe performance oi <br />construction. That I am authorized by the owner oi this property to perform the work for which arplication is made and I comply with the <br />Slate Cont a tors Law 18.2 RCW nd 296200 WAC. <br />«� � _ �. . . _.,I,.�r._ <br />�J � <br />