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SITE ADDRESS � <br />�"; / �;" <br />LOT NO. <br />DESC. <br />P �RMIT APPLICATI�,N <br />CITY OF EVERETT PERMIT 5ERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-5810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />.��� � . _ � <br />'BLOCK <br />TRACT <br />PARCEL TAX I.D. # <br />RMIT # <br />7J '.. - <br />!� <br />TENANT NAME CONTA T FOR PERMIT PHONE <br />,' . . � .,. � ��1 <br />CONTRACTOR �' ' n YH i0 ��pR�� �ysv, PHONE ��5� <br />/�C�FG� Ci''t� 7(�. <br />4"� . <br />COWTR. LICENSE A ✓) xSI//�•A `��'� �•i : . ^ �9��� !`' � �f O�/ �l <br />/7i� <br />USE OF BUILDING <br />WORK DESCRIPTION �irtSj�u�� G <br />PLU <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clolhes washur <br />Water healer <br />Sink (service/bar/mop/etc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />HEAT SOURCE /�� <br />� (�� <br />_ Electric _ Gas � Olher r' <br />i.70 Sf: �� lo,E'/.?/ <br />CONTRACT PRICE OF WORK <br />� j� �( 0 <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling unils <br />Forced air systems <br />Gas pipiny <br />Water healer <br />Gas fireplace <br />Gas range <br />Clolhes dryer <br />Range hood <br />Exhausl (an <br />Heal pumn <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />� <br />CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y thal I have read and examined this application and know lhe same to bo true and correcL All provisions o( laws and <br />ordinaces governing this type of work will be complied wilh whether specified herein or nol. The granting of a permit does not presume <br />lo give aulhority to violale or cancel the Frovision o( any other stale or local law regulating consWction or the per(ormance of <br />conslruclion. That I am aulhorized by lho owner of this property to perform the work for whi�h application is made and I comply wilh the <br />Stale Copt�Lctors Law 1827 RCW and 296.200 WAC. <br />'�v <br />