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SITE ADDRESS <br />TENANTNAME <br />CONTR. LICENSE # <br />USE OF BUILDIIdG <br />WORK DESCRIPTION <br />����•��� <br />��J <br />; <br />PtRMIT APPLICiATIUN <br />�ITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — wv�w.everettwa.org <br />APPLICATIONS ARE ACCEPT[D FROM 8 AM TO 4 Phf <br />PARCEL TAX I.D. # <br />�. I�G '7000 G <br />BLOCK TRACT OR SIIBDIVISION # <br />CONTACT FOR PER�d1T <br />�v�% f3���=! �A�� <br />HEATSOURCE <br />_ Eleclric �Gas _ Other <br />I � <br />� i�lill'( i i�/,:1_.'(� <br />NO. � 1YPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & dispasal <br />Dishwasher <br />Clolh�s washer <br />Water heater <br />Sink (service/bar/mop/elc.) <br />Dackfiow prevenler <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roo( drains <br />Olher <br />0 <br />PNONE <br />7j'Y �<?r�? <br />E•MAIL <br />CITYIZIP /r PHONE � <br />7U �'� 5��� <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handlinc� unils <br />Forced air systems <br />Gas piping <br />Waler healer <br />Gas (ireplace <br />Gas renge <br />Clothes dryer <br />Range hood <br />Exhausl fan <br />Heat pump <br />Unit heater <br />Boi�er <br />Refrigeralion <br />Wondstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify lhal I have read and examined lhis application and know lhe same to be true and correcl. All provisions o( Iaws and <br />ordinaces governing ihis type of work will be complied wilh whelher speci(ied herein or noL The granting o( a permit does not presume <br />to give authority lo violale or cancel lhe provision o� any other stal� or local law regulaling consiruclion or lhe performance o( <br />conslruction. Thzt I am authorized by fhe owner o( this property to pertorm the work (or which application is made and I comply wilh the <br />State Con�ctets �Law �7 RCW and 296.200 WAC. <br />!�`�G'/( //.�---� io-/� D % <br />Vz <br />