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SITE ADDRESS <br />LOT NO. <br />CRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-88'Q — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />5s� P� 5w <br />BLOCK <br />TRACT <br />PARCEL TAX I.D. # <br />PERMIT # <br />��� <br />....�.�R � � �� nooR$S�) TZ- 512.) ��j� �j�Zlj�J HONE�Li� 3�0 -%� <br />.�c s =fit,�JJ���EZ, � <br />TENANT NAME I CONTACT FOR PERMIT PMONE <br />CONTRACTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />�tC /�-1i ! GC_. <br />WORK DESCRIPTION <br />ADDRESS <br />HEATSOURCE <br />✓ Electric _ Gas _ Other <br />CITV/ZIP PHONE <br />CONTRACT PRICE OF WORK <br />�4l5 i�jJ7�'�c� }�j��a$-vre �%n„7_ '� 1�kSTACL it/�7� ,� <br />� � U <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher <br />Clolhes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease lrap <br />Roof drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />fvG — alr hantlling units <br />Forced air systems <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAl( CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this application and know the samc to be lrue and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whelher specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating conslruction or the performance of <br />construction. That I am aulhorized by the owner of this property to perform lhe work for which aFplication is made and I comply with the <br />State Contrac s Law 1.27 RCW and 296.200 WAC. <br />IL� 2/Z 3�U �P <br />