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SITE ADDRESS �` <br />1 ����_ <br />LEGAL LOT NO. <br />DESC. <br />TENANT <br />CONTRACTOR <br />PEKMIT APPLICATIOIV <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 ARE ACCEPTED FROM 8 AM TO 4 PM <br />�. <br />BLOCK <br />CONTR. LICENSE # �`i� / 1� � <br />/W <br />USE OF BUILDING <br />WORK DESCRIPTION <br />� L( S'f— I f('� L r-� I., t-1 �'" �- <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />I<ilchen sink & disposal <br />Dishwasher <br />� Clothes washer <br />Wa1er heater <br />Sink (service/badmop�etc.) <br />Backflow prevenler <br />Urinal <br />Drinkin� Fountain <br />Floor drain <br />_ Grease trap <br />Roof drains <br />Other <br />PARCEL TAl( I.D. # <br />TRACT <br />CONTACT FOR PERMIT <br />ADDRESS <br />HEAT50URCE <br />�� Electric 1.�Gas __ Olher <br />L <br />CITY2IP <br />PERMIT # <br />.v,r��n ��� 005 <br />PHONE <br />PHONE <br />CONTRA T PRICE OF WORK <br />�y� �t <br />NO. I TYPE OF FIXTURE OR ITEM <br />A!C — air handling unils <br />Foroed air syslems <br />' Gas pipiny <br />Water heater <br />Gas (iraplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeralion <br />_I Wuodstove <br />Other <br />CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br />I hereby ccritify that I have rad and examined this applicalion and know the same lo be true and correcL AII provisions o( laws and <br />ordinaces governiny this type of �vork will be complied wilh whether specified herein or not. The granting of a permit does nol presume <br />lo give authoriry lo violale or cancel lhe provision o( any other state or local law rec�ulaling consiruclion or lhe peAormance of <br />construction. That I am aulhorized by lhe owner of this property to perform the work fo• which application is made and I comply with the <br />State Contraclors Law 18.27 RCW and 296.200 V��AC. <br />l ( , r ,.� � /.) ��, r�i n � �1�+/ ^ O{� <br />