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SITE ADDRESS <br />N0. <br />�mP <br />CONTRi.CTOR <br />CONTR. LICENSE # <br />USE OF BUILDING <br />i J�— h <br />WORK DESCRIPTION <br />aa�t�� <br />� <br />PERMIT APPLiCATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 �'—� �`� 7 <br />425-257-8810 — FAX 425-257-8857 — www.everetlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />'�� ��. � PARCEL TAX I.D. # <br />cu�-4 bc�o� l oc <br />BLOCK TRACT <br />L-O <br />AD SS <br />1811o•S•L�Z.•5}e Y�S• <br />,� -�',r,r ^s.�.a �-t—�r.n <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal� <br />Dishwasher . .. ' <br />Clothes washer <br />Laundry tray <br />Urinal <br />Drinking Fountain <br />F!oor drain <br />Grease trap <br />Roof drains <br />Other _ <br />I CONTACT FOR PERMIT <br />_���� ' °r�_ <br />ADDRESS <br />HEATSOURCE <br />_ Electric � Gas _ Olher <br />NO. <br />rzn <br />+ev <br />� l,� 7v3-28 <br />PF:�tM1T # � � <br />L 70� --5 .� <br />PHONE L� Z 5• <br />hs, 33y•o.57_� <br />>g <br />PHONE <br />�Izs•33�1 0� �3 <br />CITYIZIP PHONE <br />CONTRACT PRICE OF WORK <br />MtGFiAIVII:FlL <br />TYPE OF FI%TURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Rangehood <br />Exhaustfan <br />Heatpump " � � <br />Unit heater <br />Boiler <br />Refrigeretion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have �ead and examined this application and know lhe same to be true and correct. All provisions of laws and <br />ordinaces goveming this type of work will be complied with whether specifed herein or noL The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulaling construction or!he 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 the <br />State Contra/Gors La 8:27 RCnW nand 296.200 WAC. <br />i S� � t� 1� 0' l%/ r O P./ / � ._. . � �.. � i.. r-i <br />� -------- ..__--�-� -- �--...-.�e <br />