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SITE ADDRESS <br />q �a a� � <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />L 1�Urn� <br />TENANTNAME <br />CONTRACTOR <br />CONTR. LICENSE # <br />Lr <br />USE OF BUILDING <br />pERMIT �►PPLICATi4N <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 />PARCEL TAX I.D. # <br />.n� r'Y�ls�'n(„�nni _nnl • OU <br />BLOCK TRACT <br />�Y l�-e� C � <br />ADDRESS <br />`1W• 1�Il�S.t�.S�ev� <br />WfIRK DESCRIPTION <br />� <br />I CONTACT FOR PERMIT <br />. i E • <br />� <br />NO. I TYPE OF FIXTURE OR ITEM <br />� Toilet <br />� Bathtub <br />� Lavatnry (wash basin) <br />I Shower <br />I I(itchen sink & disposal <br />I Dishwasner <br />i Clothes washer <br />� Laundry lray <br />Sink (servicelbadmop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Focntain <br />Floor drain <br />Grease irap <br />Roo( drains <br />Other <br />ADDRESS <br />7�i1-fi� <br />;rj'�J <br />� ��J _ <br />PE MIT # <br />� ��� _ < <br />; �- <br />L.tn�iC �i�i (' Yls <br />_ a,�zss' `� ZS�, <br />PHONE <br />. . ' . <br />CITY2IP PHONE <br />. • .' � <br />. � <br />HEATSOURCE <br />_ Electric �Gas _ Other <br />. •�r+ �," <br />CONTRACT PRICE OF WORK <br />NO. I TYPE OF FIXTURE 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 />Range hood <br />Exhaustfan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Olher _ <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br />I hereby ceritify that I have read and examined thls application and know the same lo be true and correcL All provisions of laws and <br />ordinar.as governing this type of work will be complied with whether specifed herein or not. The granling of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the periormance of <br />construction. That I am authorized 6y the owner of this propeRy to pertorm the work for which application is made and I comply with the <br />State Contractors Law,1827 RCW and 296.200 WAC. � <br />. J �• !�J �,�: <br />