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SITE ADDRESS <br />LOT NO. <br />a <br />PERi►►�IIT APPLICAiION <br />CITY OF EVERETT PERMIT SERVIC'ES <br />3200 CEDAR STREET, EVERETT, WA 98201 �`�'"0 7 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ii.Yl � t r� <br />OLOCK <br />PARCEL TAX I.D. # <br />ooc ���r�,� � �o l G� %� <br />TRACT \_ � <br />.Aa(wYl UPC'�'U _-- <br />i�l,� 703 Z7 <br />I PERMIT# \1 <br />AUORESS (� CITYIZIP PHONECI�l.3` <br />I�ll� •��2.�eveY�s l�lZ.�e vett5 <br />R�#ZC� WAqRzSg v573 <br />TENAPIII NAM� CONTACT FOR PERMIT PHON OS 7 3 <br />C .1� y25• 33 • <br />�r^.�1� �.s R�-r,ve �c'„� -�� P(-�.�,r, .ox�.22� <br />CONTRACTOR ADDRESS CITYIZIP PHON[ <br />CONTR. LICENSE # <br />USE OF BUILDING <br />WORK DESC;RIPTION <br />a�sy <br />N0. I NFE OF FIX7URE OR ITEM <br />� Toilet <br />a Bathtub <br />� Lavatory (wash basin) <br />_j_ Shower <br />� Kitchen sink 8 disposal <br />� Dishwasher ' '' � <br />� Clothes washer ` ' <br />Laundry tray <br />Sink (service/bar/mopletc.) <br />BackFlow preventer ' <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Uther <br />HEATSOURCE <br />Electric � Gas _ Other <br />N0. <br />CONTRACT PRICE OF WORK <br />NICAL <br />NPE OF FIXTURE OR ITEM <br />A/C — air handiing units <br />Forced air syslems <br />Gas piping <br />Waten c�ater <br />Gas freplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhailst fan a <br />Heat pump � " ' <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />CITY OF EVERETT LOCAL S.1LES TAX CODE IS J105 <br />�' <br />I hereby ceritiy that I have read and examined this application and know the same to be true and correct All provisions of laws and <br />ordinaces governing this type of work will be ccmplied with whether specified herzin or not. The granting of a permit does not presume <br />to give authority to violale or cancel the provision o( any other state or local law regulating constniction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with !he <br />State Conlractors Law 18.27 RCW and 296200 WAC. <br />