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SITE ADDRESS <br />Q"s 2 '! i �' <br />��c:.�l �oT No. <br />PEr21VllT APPLICATION <br />Cli'Y OF EVERETT PERMIT SERVlC�tS <br />32C� CEDAR STREET, E'IERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — ww�ti�.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AN TO 4 PM <br />, <br />;�)�~; I, <br />BLOCK <br />TENANTtJAME / <br />CONTR.4CTOR <br />CONTR. LICENSE # / /,�/r+/�" <br />�,i��ir <br />USE OF t3UILDING <br />WORK DESCRIPTION <br />��J�D l� <br />PARCEL TAX I.D. # PERMIT # <br />{�oi� o�� lv 3�� 1 ��a=tx�! <br />TRACT <br />ADDRESS <br />i - �' <br />� �S <br />iCON7ACT <br />ADDRESS <br />'/'i°l'� <br />NO. I TYPE 7F FIXTURE OR ITEM <br />To�let <br />BalhWb <br />Lava!ory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clo.hes washer <br />Watar healer <br />Sink (service/bar/mop/etcJ <br />Backflow prevenler <br />'Jrinal <br />Drinking Fourtain <br />Floor drain <br />Grease trap <br />Root drains <br />Olher <br />PHONE <br />PHONE <br />CITYIZIP PHONE <br />/ <br />/ �� 311 � />;,r+-1 1 / <br />HE,4T SOURCE � / CONTRi,CT PRICE OF WORK <br />Eleclric Gas Ot;�er <br />� <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling uniis <br />Forced air systams <br />Gas piping <br />Waler heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust (an <br />Heal pump <br />Unil heat�r <br />Boiler <br />Refriyeretion <br />�Voodslove <br />Other _ <br />CITY OF EVERETT LOCAL SALE�� TAX CODE IS 3105 <br />I hereby ceritity thal I have read and examined lhis application and know the same to be lrue and currecL All provisions of Izws and <br />ordinaces goveming this type of ork will be romplied wilh whether speciilad herein or not. The granting oF a p�rmit does not presume <br />lo give authority to violale or can� ihe provision of any other state or local law regulating consWction or the pedormance of <br />consL�ction. That I am aulhoriz y the owner of this property lo pertorm the work for which application is made and I ccmply with lhe <br />State ConVaclors Law 18.27 R and 296.2001NAC. ����t <br />, ��� � <br />Signature of OwneriContr�Clor ,uth zed Agent Dale \� <br />