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SITE ADDRESS <br />LOT NO. <br />�� <br />PERMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERViCES <br />3200 CEDAR STREET, EVERETT, WA 9a201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK � TRACT <br />PARCEL TAX I.D. # <br />�7 -oD/-ilDO'oDD <br />J^ • <br />PERMIT # <br />v�nG.��— <br />.�-�E r��: f/o U.r�N l q�r,s%,e 3i� 7 �i �aY' �vF �PZoi %2.T.�a3 //2 / _ <br />TENANTNAME CONTACTFORPERMIT PHONE <br />�o.r� �r/�'�CF i�Z S S�O� �� �D — <br />CONTRACTOR ADDRESS CITY2IP PHONE <br />%F�FTTf/t�✓'/N6 flvTHv/' . .�/o� �'uC/,j�ffdc 9�2�/ �/Z,T.Ta�63�0 <br />CONTR. LICENSE # <br />USE OF BUILDING <br />s%� <br />WORK DESCRIPTION <br />HEAT SOJARCE <br />/ <br />Electric V Gas _ Olher <br />/�'���i2�k'�/��;��� �`,�i,rr/��G /��'sio���� <br />�P� <br />■nd��:l��[r: <br />TYPF OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Uishwasl �er <br />Clothes washer <br />1,Naler heater <br />Sink (service/badmop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Other <br />CONTRACT PRICE OF N10RK <br />� <br />TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air syslems <br />Gas piping <br />Water heater <br />Gas (ireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhauslfan <br />Heat pump <br />Unit heaier <br />Boiler <br />Refrigeralion <br />Woodslove <br />Ulher <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify thal I have read and examined this application and kno�v the same to be lrue and correcl. All provisions o( laws and <br />ordinaces governing Ihis rype of work will be complied with whether specified herein or not. The granting of a permit does nol piesume <br />to give aulhority to violate or cancel lhe provision o( any olher state or local law regulaling construction or lhe pedormance of <br />construction. Thal I am aulhorized by the owner o( ihis properly to perform Uie work (or which application is made znd I comply with the <br />State Contrar.tprs,l,aw 18.27 RCW and 29E.200 WAC. <br />'a-3��-0 <br />