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SITE ADDRE55 <br />a U o� 5 <br />LECAL LOT N0. <br />DELC. <br />OW NER <br />���� I� <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 />APPLICAYI9NS ARE ACCEPTED FROM 8 AM TO 4 PM <br />� _ S� V <br />, <br />BLOCK <br />:AGTUK <br />�n��c�l Nt'c�i�►�c� <br />L LICCN E # <br />USE OF BUILDING <br />WORK DESCRIPTION <br />� �<,�1 I � � �i� � <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIViSION #.: <br />�1t�1.5fst� s7-s� <br />CiJNTACT FOR PERMIT <br />�ICQ �� ��e-�r�t �n �,�x1 �l <br />I — IiEAT SOURCE <br />Eleclric �Gas _ <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ Toilet <br />BathWb <br />Lavatory (wash basin) <br />Shower <br />Kilchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Backtlow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />I hereby c <br />ordinaces <br />to g��e au <br />t�th I have r ad and c <br />iernin lhis ry e of work <br />ity lo v lale cancel lt <br />Thal I auth 'zed by <br />:lors La 18.27 R r <br />� �(,G� �Vl�l�l C(� <br />�J <br />Other <br />8Z�3 �lzs <br />PHONE <br />E-MAIL <br />I IZIP <br />��� <br />/ - 00� <br />�ZS z�� <br />CONTRACT PRICE OF WORK <br />�� <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC – air handling units <br />� rorced air systems <br />_ Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br />iined this apGlication and know the same to be true and cortect. All provisions of laws and <br />be complied with whelher specified herein or not. The granting of a permit does not presume <br />ovision of any other state or local law regulating construcGon or the perfortnance of <br />owner of this propeAy to eriorm the work for which applicalion is made and I comply with the <br />��I� � I �f� � <br />�I. I , <br />